General Referral Form
IUD/IUS Referral Form
MD SA Referral Form

At VIWC we see women who....

  • need a pap and sti screening and DO have a regular GP *require referral*
  • have a threatened, suspected or known miscarriage *require referral*
  • need endometrial biopsy, +/- Mirena insertion, for heavy menses *require referral*
  • have unplanned pregnancies
  • need birth control including IUD insertion
  • have concerns about IUD
  • are of secual and reproductive age (25+) and need routine Paps and /or STI check and DO NOT have a regular GP 


 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.