Please complete this form to make a referral for yourself or someone you care for.

We will contact you in order to get more information about which service

will best suit your need.

If you would rather submit a written form

Client Consent/Referral Form

—  click to download and print  —

This printed form can be dropped off at our office in Cranbrook or scanned and emailed to info@ckhospice.com .

If you prefer, phone and leave your information in a message at 250 417 2019 /toll free: 1 855 417 2019