DI and MRI Request for Consultation Forms


Cambridge Memorial Hospital is pleased to accept physician e-Referrals directly from our website:



For Telus Practice Solutions, Oscar and Accuro EMR users 

  • Please see below to download custom forms that send eReferrals directly to CMH from your PS Suite EMR (with no additional login required). 

PS Custom Form for Ocean eReferrals  (needed by all DI eReferral forms)

PS Custom Form for Diagnostic Imaging eRequisition 

Click here for installation instructions. Note: please ensure that you install the custom forms in your clinic before attempting to send a referral. 


e-Referral Support

If you require assistance with your e-referral, please contact us. 

  • E-mail:   ereferralsupport@cmh.org 
  • Diagnostic Imaging:  (519) 621-2333 ext. 2230 
  • MRI:  (519) 621-2333 ext. 4968


For other EMR users or those without an EMR

  • If you do not wish to send an eReferral, faxed referrals are still acceptable.

Diagnostic Imaging Referrals (fax forms)

Fax Numbers

  • MRI Referrals:(519) 740-4969
  • DI Referrals: (519) 740-4904