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Referral Forms

If you are a physician referring a patient to our clinic, please complete the following form and fax it to us:

Physician Referral Form

If you are a patient seeking care and wish to self-refer, please fill out the following form and fax it to us:

Patient Self-Referral Form
Find Us

Room 541
5th Floor, Burrard Building
St. Paul’s Hospital
1081 Burrard Street
Vancouver, BC V6Z 1Y6

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