Referral forms

Breast Cancer Suspicion Algorithm

Referral Guidelines

Referral Forms

Breast Imaging Referral Form

Referral for Surgical Consultation

Lymphedema Referral Form

Hereditary Breast Cancer Clinic Referral Form

Family history questionnaire for the Hereditary Cancer Clinic

No referral form needed for the following services. Please contact directly.

Referral for Nutrition Services – Ph: 204-235-3646 or fax request to 204-231-3839

Referral for Psychosocial Counselling – Ph: 204-258-1004 or fax request to 204-231-3839

If you have questions about our services or the referral process, please call the Centre from Monday to Friday (between 8:00am – 4:00 pm) at 204-235-3906 or Toll-free at 1-888-501-5219.

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Traditional Territories Acknowledgement
The Winnipeg Regional Health Authority acknowledges that it provides health services in facilities located on the original lands of Treaty 1 and on the homelands of the Metis Nation. WRHA respects that the First Nation treaties were made on these territories and acknowledge the harms and mistakes of the past, and we dedicate ourselves to collaborate in partnership with First Nation, Metis and Inuit people in the spirit of reconciliation.
Click here to read more about the WRHA's efforts towards reconciliation

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