Refer A Patient
Referral to the program must be made by a nephrologist or a general practitioner and must meet these criteria:
Kidney or Liver cysts confirmed by diagnostic imaging (i.e. ultrasound, MRI or CT)
Completed referral form along with; a brief medical history, the most recent lab results (including serum creatinine) and the most recent diagnostic imaging report
To complete the referral process, please download and complete the CIMPKD Risk Assessment Referral Form
Please fax the completed form to 416-340-4999 (Attn: CIMPKD), along with the patient’s medical history, lab and diagnostic imaging reports. Please do not send patient information or referrals via the CIMPKD email address.
Our office will fax you with information regarding the patient's first appointment and will mail the appointment information directly to the patient.
If you have polycystic kidney disease and would like to be seen at the CIMPKD, please have your nephrologist or family doctor fax the attached referral form to the CIMPKD office.