1

Complete form as fully as you can

Print the form and fill it out according to the instructions below:

If you are a community nurse or physician's office:

Please provide as much of the requested documentation as possible to assist with triage. See the boxes on the bottom half of the referral form for a list of what information we require for different referral types.

If you are a community agency or support worker booking on behalf of a client: 

Please fill out as much information as possible and let us know which physician's office, community nurse, or hospital we can obtain your client's medical history from.

2

Fax the referral and documentation

Please fax the referral and all attached documentation to our confidential fax at (604) 875-3063.