varicose veins removal patient referral

Patient Referrals


If you are a healthcare professional looking to refer a patient please download and fill out the form below. Completed forms can be faxed 604-986-4701 or emailed to directly to Varicose Vein Clinic of BC office.

If you have any questions or concerns, please contact our office directly by phone or submit your questions online, and one of our team members will be happy to assist you. Online inquiries receive a response within 24 – 48 hours.


A process that’s easy for you, your staff and your patients

1. Complete our referral form for a consultation and provide your signature.

2. Make a copy for your patient and then email or fax 604-986-4701 the referral form to our office.

3. Once we receive your referral we will contact your patient to schedule an appointment. Failure to reach the patient will result in a follow-up call to your office.

4. Once an appointment is scheduled, we will inform your office of the appointment date noted on the original referral form and fax it back to your office.

5. Post consultation notes, reports and post-procedure reports will be faxed to you within 48 hours of the appointment.

    Your Name (required)

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