Referral Information for Pediatric Gynecology

Young girls and adolescents are seen for gynecological complaints as well as gynecologic problems related to endocrine, developmental, or growth disorders.

To Schedule an Appointment:

Main Office: (802) 847-1400

Fax: (802) 847-8433

Location:
Main Pavilion, Level 4
Medical Center Campus
111 Colchester Avenue
Burlington, VT 05401

Office Hours
2nd and 4th Wednesdays, 1:00 pm-5:00 pm
Other appointment times are available as needed.
Use Provider Access Service 800-639-2480

Referral Information
The Pediatric Gynecologist needs the following information to provide the best care for your patient.

Medical/Surgical Information

Most Important

  1. Name of Referring MD/Provider / Phone / Fax
  2. Reason for Referral and Expectations
  3. The Specifics of the Complaint
  4. Past Medical and Surgical Documentation
  5. Weight and Growth Charts for Developmental Disorders

Patient Demographic Information
Name, Date of Birth, Parents' Full Names, Address, Phone Number, Insurance Plan