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
This printed form can be dropped off at our office in Cranbrook or scanned and emailed to email@example.com .
If you prefer, phone and leave your information in a message at
250 417 2019 or toll free: 1 855 417 2019