Refer a Patient for a PET Scan

The PET Scans Ontario Program provides referral forms and instructions for healthcare providers to refer an Ontario patient for a PET scan.

There are several ways to request a PET scan:

• Fill out a requisition and send it to a PET scan centre.
• Apply to the PET Access Program for a case-by-case review.

The following instructions apply to all PET scan referrals.

Referral Instructions

For Ontario patients receiving a PET scan within Ontario

1. Review the Indications to confirm the patient’s eligibility.
2. Download and complete the relevant form (see forms in sidebar).
3. Gather supporting documentation as specified in the form.
4. Submit the completed form by fax to your PET centre or PET Scans Ontario, as instructed on the form.

For Ontario patients receiving a PET scan in another province

1. Complete the Out-of-Province (OOP) PET Access Referral Form (see form in sidebar).
2. Gather supporting documentation as specified in the form.
3. Submit the completed form by fax to PET Scans Ontario, as instructed on the form.

Notice of Collection

Ontario Health (Cancer Care Ontario) collects personal health information (PHI) in the Pre and Post PET Scan Packages under the authority of the Connecting Care Act and the Personal Health Information Protection Act. The information is used to:

• determine patient funding eligibility
• support reimbursements 
• support provincial health system planning 

When evaluating a request, we may need to disclose the patient's PHI to other administrative programs for health services and insured benefits. 

If you have questions about this collection, call us at 1-877-473-8411 or email OH-CCO_PETScansOntario@ontariohealth.ca.