Referral Forms for Health Professionals

Heart Function Clinic

• Cardiac Rehab/Risk Reduction and Heart Function Clinic Referral Form
• Echocardiography Request for Exam Form (Note: this form is for South Island Inpatients only).
• Myocardial Perfusion (MIBI Scan) Req
• VGH - Urgent Medical Assessment Clinic ref form
• Physician Recommendations for Exercise May 2010

Kidney Care Clinic

• Kidney Care Clinic Referral Form South Island
• Kidney Care Clinic Referral Form Central Island

Mental Health and Addiction Services

• Mental Health Intake Referral Form
  (Note: this form is for Physician use only, and refers to South Island services only).
• Application for Psychiatric Medication Coverage (BC Ministry of Health)

Diabetes Education Centre

• Diabetes Education Centre referral form for SI
• Diabetes Education Centre referral form for CI and NI

Standard Outpatient Requisition Forms - Effective January 2010

• Memo re: Working Committee to Review Standard Outpatient Requisition Forms
• Standard Outpatient Requisitions Forms for Lab and Medical Imaging