Referrals

Cardiac Prevention Clinic
Healthy Heart Program Prevention Clinic Referral Form
Cardiac Sarcoidosis Clinic
Cardiac Sarcoidosis Referral Form
Cardiology Telehealth Referral Form
Use this form if you want to book a Cardiology telehealth visit.  If you download this form, it is fillable for your convenience:  Referral to Cardiology Telehealth
Atrial Fibrillation Clinic Referral Form

See Cardiac Clinics Referral Form above.  For patients with known or suspected atrial fibrillation who are not yet on recommended treatments.

Yasmin & Amir Virani Provincial Adult Congenital Heart Program

VPACH Referral Form

Yasmin & Amir Virani Provincial Adult Congenital Heart Program (VPACH)

- Assessment and cardiac management for adults with congenital heart disease.

Cardiac Obstetrics Clinic Referral Form

COB Referral 

Cardiac Obstetrics (COB) - Pre-pregnancy counseling and cardiac care to women with congenital and acquired heart disease at risk of developing heart complications during pregnancy. Please include number of weeks pregnant.

Heritable Aortopathies (HA)

Comprehensive, multisystem assessment genetic disorders that effect the aorta. 

Heritable Aortopathy Clinic Referral Form

BC Inherited Arrhythmia Referral Form

Referral Inherited Arrhythmia

Multidisciplinary screening, evaluation and genetic counseling for patients/families affected by, or at risk for, an inherited arrhythmia, sudden unexplained cardiac arrest, sudden unexplained death, or sudden infant death syndrome

Transcatheter Valve Implantation Referral Form

Information for Referring Doctors for THV

Information for doctors who want to refer patient who have significant valvular disease and is suitable for Transcatheter Valve Implantation. 

THV Referral 

Refer if your patient has significant valvular disease and is suitable for Transcatheter Valve Implantation. This forms goes with the General Cardiology Referral Form and the Lab Requisition for General Cardiology Referral.

Pacemaker or Implantable Defibrillator Referral Form

Pacemaker Referral Form

Implantable Defibrillator Referral Form

If your patient requires assessment for or insertion of either of these devices.

Hypertrophic Cardiomyopathy Clinic

Hypertrophic Cardiomyopathy Clinic Referral Form

Chest Pain Clinic Referral Form

Chest Pain Clinic Referral Form

Other Referral Forms

Laser Lead Extraction Program Referral Form

Surgical Mitral and Tricuspid Valve Clinic 

Cardiac Clinics Referral Form
This is a generic form that can be used for all St Paul's Cardiac Clinics including Cardiac Rehab.  Open form

Contact Information

If you have questions regarding referrals or require more information, please contact:

Email: Heartcentreprogram@providencehealth.bc.ca
Phone: 604.806.9139 | Fax: 604.806.9150