Gastroenterology Referral

Use this online form to refer a patient to Dr. Ali Alharethi at Heart and Health Clinic.

Alternatively, you can refer patients to us through the Ocean Referral System or by downloading and sending the referral form by email or fax.

Central Booking Line

T: (289) 760-9550
F: (905) 296-3858
E: clinic@heartandhealth.ca

Our Clinic Locations

Reason for Referral


Gastroenterology

Service(s) Requested


Type your first and last name below to act as your e-signature for the purpose of this referral.