Online Patient Referral Form

Patient Information

Contact Information *

Referring Doctor
Reason For Referral

Please enclose all relevant medical records, test results and imaging reports

Clinic Information

Select Location:

Prefer our Prince George location (Blossom Fertility)? Click here.

Select Physician

Located in Vancouver

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Located in Kelowna

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Located in Victoria

Surrey Selected

Physician: Dr. Shaun Tregoning

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