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Referral Forms for Health Professionals

Please note: These forms are intended for use by health professionals only.

Heart Function Clinic
• Heart health referral forms and processes


Home and Community Care
• South Island Referral Form (pdf)
• Centre Island Referral Form (pdf)
• North Island Referral Form (pdf)


Mental Health and Addiction Services
• Mental Health Intake
• Application for psychiatric medical coverage (Plan G - BC Ministry of Health)


Diabetes Education Centre
• South Island Diabetes Education Centre Referral Form (pdf)
• Diabetes Education Centre referral form for CI and NI (pdf)


Seniors Health Referral Form
South Island Seniors Health Referral Form (pdf)
North Island Seniors Health Referral form (pdf)


Pain Program
Pain Program referral form and process


Central Island Healthy Lifestyles
Central Island Healthy Lifestyle Referral Form (pdf)