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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


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


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
• Diabetes Education Centre referral form for CI and NI


Seniors Health Referral Form
South Island Seniors Health Referral Form
North Island Seniors Health Referral form

Pain Program
Pain Program referral form and process