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Esophageal Disease Rapid Assessment & Management Program (ESORAMP) - Referral

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Urgent Referral

If your patient needs immediate, urgent care, please do the following:

If you do not know which physician to refer your patient to, please call Gita Singh at 416 340 3383. You will be directed to the correct physician.

You must make direct contact with the appropriate physician to complete an urgent referral.

Please note: All referrals are considered urgent.


Standard Referral

To complete the standard referral process, first download and complete the name of referral form.

Once you have completed the form, fax it to Gita Singh at 416 340 3776 or directly to the physician. Some physicians' offices will send you a confirmation of receipt.

The form will be reviewed to ensure that it is complete; if incomplete, the form will be returned to you.

Our office will call you with information about the patient's first appointment.

Your office is responsible for providing the patient with the appointment information, including time and location, and important documents, test results and imaging that they must bring.

It is extremely important to ensure that your patient brings the following tests as these will be required at their first appointment.

  • Swallow studies
  • Endoscopic reports
  • CT and/or PET scans

Checklist for a Complete Referral

In addition to the completed referral form, make sure to include:

  • Pathology results
  • Clinic notes

If this information is not included with the referral form, your referral may be returned as incomplete.

More Referral Links


Go to the Esophageal Disease Rapid Assessment & Management Program