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Gynecologic Cancer Referral Information for Providers

To refer a patient or for assistance in navigating the Virginia Mason Health System, we have several resources available for your convenience:

Please ensure that you include the following pertinent information:

  • History and Physical/Chart notes
  • Medication /Allergy List
  • Lab Results
  • Pathology Reports
  • Radiology Reports (CT, MRI, X-Ray, US, and HIDA)
  • Patient Demographics

Online Physician Referral Form

Note: Online submission form ONLY.
Please DO NOT PRINT and fax in this form.
If faxing a referral, use the Patient Referral Fax Form.