General Referral Form
IUD/IUS Referral Form
Miscarriage Referral Form

At VIWC we see women who....

  • need a pap and sti screening and are between the ages of 25-50  (we require a referral only if you have a GP)
  • need a pap and sti screening and are between the ages of 50-69 (we require referral)
  • have a threatened, suspected or known miscarriage (we require referral)
  • need endometrial biopsy, +/- Mirena insertion, for heavy menses (we require referral)
  • have unplanned pregnancies
  • need birth control including IUD insertions (require referral if seen by GP)
  • have concerns about IUD


 We currently DO NOT see women who:

  • need or want a female GP
  • have menopausal concerns
  • have any other gynecolgical concerns

Referring a Patient....

We appreciate that you are letting your patients know about our services. For ease of sending referrals here are some forms for your use to fill out and

fax to 250 480 7339.