Referral Form - Fraser Health Authority 2026

1. Click ‘Get Form’ to open the Referral Form in the editor.
2. Begin by entering the 'DATE OF REFERRAL' at the top of the form. This is essential for tracking purposes.
3. Fill in the 'Patient Information' section, including surname, first name, middle name, address, home phone, cell phone, date of birth (DOB), age, and personal health number (PHN).
4. Complete the 'Referring Physician' section with your details including name, address, telephone numbers, and fax number.
5. Indicate if an interpreter is required and specify the language if applicable.
6. In the 'Reason for Referral' section, tick all relevant boxes and mark any diagrams as necessary.
7. Attach any recent diagnostic reports as indicated in the form. Ensure to provide details about previous screenings or procedures.
8. Review all information for completeness to avoid delays. Incomplete referrals will be returned for additional information.
9. Finally, sign and date the form before submitting it via fax to ensure proper processing.

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