FOR PROVIDERS - FOR PATIENTS
Requisition forms.
THREE STEPS
From form to follow-up.
Whether you’re a referring physician sending a patient our way or a patient bringing your own paperwork, the process is the same.
01 — DOWNLOAD
Pick the right clinic
Find the Wosler location where the patient will be seen. Each location has its own requisition with the right fax line and clinic details pre-filled.
02 — COMPLETE
Fill out the form
Open the PDF, complete all required fields: patient details, exam requested, clinical history, and ordering provider information, and sign.
03 — SUBMIT
Send it to us
Submit by fax, email, or via the booking page — see submission options below. We’ll contact the patient to schedule once we receive the requisition.
X-ray and pain management imaging are available only at our Calgary locations. All other Wosler clinics offer ultrasound only. If you’re requisitioning X-ray or pain management, please use the Calgary form regardless of where the patient lives.
CHAPTER 01 — FORMS
Find your clinic. Download the form.
Alberta 9 clinics
Calgary
ULTRASOUND - X-RAY - PAIN MANAGEMENT
Calgary Pain Injection
ULTRASOUND - X-RAY - PAIN MANAGEMENT
Cochrane
ULTRASOUND
Saskatchewan 7 clinics
Kamsack
ULTRASOUND
Onion Lake
ULTRASOUND - WEDNESDAY ONLY
Lloydminster
ULTRASOUND
Regina
ULTRASOUND
Meadow Lake
ULTRASOUND
Yorkton
ULTRASOUND
Melville
ULTRASOUND
Nova Scotia 1 clinic
CHAPTER 02 — FOR PROVIDERS
Three ways to submit.
Choose whichever method fits your workflow. Completed requisitions are reviewed within one business day, and we contact the patient directly to schedule.
01
Fax
Fax the completed form to the clinic listed at the top of the requisition. Each clinic has its own fax line printed on the form. Confirm transmission, then call the clinic if you need urgent acknowledgement.
02
Email a scanned or digitally signed PDF to referrals@wosler.ca. Use a secure email service when transmitting protected health information. We acknowledge receipt within one business day.
03
Booking Page Upload
Once the physician has signed the requisition, the patient can upload it directly while booking online. Go to booking →
FOR PATIENTS
Your physician must sign the requisition. Wosler can’t perform an exam without a valid signed referral from a licensed healthcare provider. Contact us if you have questions.
