mail@provincialendoscopycentre.com
Unit #2-1825 Provincial Road, Windsor Ontario N8W 5V7, Canada
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(519) 254-0077
Fax:
(519) 946-3518
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Referring Physician Information
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Reason for Referral *
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Gastroscopy
Colonoscopy
Sigmoidoscopy
Anorectal & Others
Reasons for Gastroscopy
Anemia
Nausea
Dysphagia
Weight Loss
Dyspepsia
REFLEX SYMPTOMS(GERD)
Reasons for Colonoscopy
Rectal Bleeding
History_of_polyps
Bloating/Gas_Flatulence
Colon screening
Reasons for Sigmoidoscopy
Constipation
Diarrhea
Anemia
Weight loss
Anorectal & Others
Haemorrhoids
Skin Tags/Lesions
Fissure-in-Ano
Sebaceous Cyst
Fistula-in-Ano
Anusitis
Other:
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Urgency
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URGENT
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Exclusion Criteria for the PEC Clinic
CARDIOVASCULAR:
Recent MI <6 months OR unstable angina
CHF
Severe valvular heart disease
PULMONARY:
Severe COPD / Emphysema (on home O₂)
Severe sleep apnea (CPAP)
Morbid obesity (BMI)
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