BLADDER CARE CENTRE

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DOCTOR’S REFERRAL FORMS

Thank you for referring your patient to the UBC Hospital Bladder Care Centre. Please note that only complete referrals will be accepted prior to booking. Incomplete referrals will be faxed back to the sender. Referrals must include: a complete referral form, a letter outlining medical / psychiatric history, disabilities, as well as, current medications and dosage.

Please be advised that patient’s referral for NCA, Pelvic Floor Physiotherapy,
Self – Catheterization Teaching and Pessary Fitting must come from a urologist.

Please remind your patients there is a 6-8 week referral wait list, and our Bladder Care Centre clerks will contact your patient to book an appointment. Due to high call volume, please remind your patients not to call the centre with regards to their referral prior to this time. We will not return their calls about their wait-list status and wait-times. Thank you.

(Referral forms must ONLY be filled out by a physician. Patients are PROHIBITED from completing this form and referring themselves to the Bladder Care Centre independently.

If you are having incontinence issues or bladder problems, please contact your family doctor or walk-in-clinic physician in order to be referred to our clinic. Patients who DO NOT have a doctor’s referral will NOT be accepted to the Bladder Care Centre. Thank you).

Click on the link below to print out a physician’s referral form.  Fax the COMPLETED referral form (please ensure to indicate the mobility and disabilities of your patient) and the patient’s medical history to: 604.822.6984

Click here to download and print the NEW Doctor’s Referral Form

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CLEAN INTERMITTENT CATHETERIZATION FORM

If your patient needs to learn how to Self-Catheterize with a Bladder Care Centre Registered Nurse, please click on the link below. Fax the completed Self – Catheterization teaching referral form with the Doctor’s Referral Form to: 604.822.6984

Please remind your patients the clean intermittent catheterization teaching is performed by a Registered Nurse, as per Doctor’s orders. The teaching and review takes approximately 60 minutes. Please ensure to pay for 1.5 hours in the parkade if you are scheduled to have this test.

Click here to download and print the Self Catheterization Teaching Referral Form

 

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