Thank you for submitting a Self Referral Form

Is it your first visit to the clinic?

If your physician hasn’t already sent us a referral please download the appropriate form below and have them fax it to our clinic. If you have any questions, please feel free to contact our Referral Coordinator, Jasmin, at 604-422-7276 or toll free at 1-866-481-7276.

• PCRM EDMONTON Fertility Referral Form  Fax to: 780-990-4443  NEW
• PCRM Fertility Referral Form  Fax to: 604-434-5522
• PCRM First Trimester Screening Referral Form  Fax to: 604-434-5522
• PCRM Prenatal Screening & NIPT Referral Form   Fax to: 604-434-5522