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Women’s Health Procedure Clinic

Please download the clinic referral form for the family medicine run Women’s Health Procedure Clinic at the Mount Sinai Academic Family Health Team, created in order to provide timely access for IUD insertions/removals, contraceptive implant insertion/removals (Nexplanon) and endometrial biopsies.

For those of you in a FHO model please note that completion of this referral form allows the Women’s Health Clinic physician to use a billing code that will not negatively impact your outside use.

When referring your patients:

  1. Please remind your patients that this clinic is being held at the Mount Sinai Academic Family Health Team located at 60 Murray Street, 4th floor – NOT in the main Mount Sinai Hospital building.
  2. Please provide your patient with a prescription for Nexplanon or the IUD.
  3. Please advise the patient to bring the IUD/implant to their Women’s Health Clinic appointment.
  4. Please ask the patient to take 400mg of ibuprofen 1-2 hours before their scheduled appointment time (if no contraindications).
  5. Note that any abnormal laboratory results will be communicated directly to the referring physician to ensure that an appropriate follow up plan is in place. 

Thank you for sending your referrals. We hope this clinic will provide your patients with timely accessible care for the above mentioned Women’s Health procedures.

Referral Form

Download the form to refer new patients.