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