REFERRAL FORM

A woman should be referred as early as possible after confirmation of pregnancy. You are eligible if your family physician does not provide maternity care at BC Women's Hospital, and you live in Vancouver or have previously had a baby at BC Women's Hospital. Complete the online referral form(below) or you can download the Referral PDF and fax or mail it:

Diagnostic/Ambulatory Clinic
BC Women’s Hospital & Health Centre
Room 1U29, 4500 Oak Street
Vancouver, BC V6H 3N1

Phone: 604-875-3436 (1st appt and general inquiries)
604-875-2160 (follow-ups and lab results)
Fax: 604-875-3950
Email: isen@cw.bc.ca

2 Ways to Send in a Referral Form:

	FAX - please print the following PDF and fax back to us. Self Referral Form (to be filled out by yourself) Or Physician Referral Form (to be filled out by your Physician)
	Online Form - fill out online and send now. Self Online Referral Form (to be filled out by yourself) Or Physician Online Referral Form (to be filled out by your Physician)

We will contact you for an appointment and notify your referring physician’s office about the appointment date.