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How to make a referral

Instructions for Patients

Referrals to the Diagnostic Assessment Program (DAP) should be made by a family physician or other treating physician involved in your care. If you are a patient wishing to be referred to the Mount Sinai Hospital DAP, please ask your doctor to make the referral.  

Instructions for Referring Physicians

  1. Complete and FAX our DAP referral form below to [provide FAX number]
  2. The Navigator will contact the patient after the referral is received and will offer patient support and navigation.
  3. The patient and referring physician’s office will be notified of the patient’s appointment with the surgeon by the Navigator within 48 hours (2 working days) of receiving the referral.


Referral Form: Download The Patient Referral Form »



  • The endoscopy and pathology results (if applicable) should be discussed with the patient before the referral is made. The nurse navigator will not discuss pathology results over the phone with the patient.
  • Staging investigations will be coordinated by the Nurse Navigator in consultation with the assigned DAP surgeon.
  • Please provide a Creatinine for all patients over the age of 60 years when possible.