Online Holter Requisition | The Holter Company

Complete a comprehensive Holter monitoring requisition online. Our digital form captures full patient demographics, clinical indications, medications, and physician information for ordering 24–72 hour cardiac studies.

Form Includes

• Patient demographics (name, date of birth, health card, address, phone, email)
• Clinical indications and presenting symptoms
• Current medications and known allergies
• Referring physician information
• Monitoring duration selection with OHIP codes (G684, G685, G659)
• Urgency level designation