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黑料网爆吃瓜.CA / Cancer Prevention / Clinical Services / High Risk Breast Clinic (HRBC)

Patient Resources & Forms

This page includes helpful resources for patients and referring clinicians. If you cannot find the document you need, please contact the clinic.

Forms

HRBC Referral Form (PDF)

This form must be completed by a licensed healthcare provider to refer a patient to the High Risk Breast Clinic for assessment and triage.

Instructions:

Please complete the form in full and email it securely to聽highrisk.breastclinique.ccomtl [at] ssss.gouv.qc.ca. Incomplete referral forms may delay triage and processing.

For Accepted Patients Only

New Patient Intake Questionnaire (PDF)听听

Important:聽This questionnaire is聽not a referral form. It is intended only for patients who have already been triaged, formally accepted to the High Risk Breast Clinic, and placed on the waiting list. Completion of this questionnaire does聽not聽constitute a referral or guarantee clinic acceptance.

Instructions:

After completing the questionnaire, please email it to聽highrisk.breastclinique.ccomtl [at] ssss.gouv.qc.ca. This document should only be submitted if you have been instructed by the clinic to do so.

Preparing for your visit

  • Bring your RAMQ card and your Jewish General Hospital card (if you have one).
  • Bring key reports if available: imaging, pathology, genetic test results.
  • Arrive early to allow time for hospital registration if needed.

Contact

  • Phone: 514-340-8222 ext. 28775
  • Email: highrisk.breastclinique.ccomtl [at] ssss.gouv.qc.ca
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