Referral Forms for Health Professionals

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

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

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

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)

Nanaimo Regional General Hospital Orthopaedic Services
• Orthopaedic Referral Form (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