Referral Form - PHSA - BC Children's Hospital 2026

1. Click ‘Get Form’ to open the Referral Form in the editor.
2. Begin by filling in the child's name, date of birth, and sex in Section I. Ensure all details are accurate for proper identification.
3. Specify the school attended if the child is of school age to facilitate the intake process.
4. Complete the parent’s names, telephone number, and address fields to ensure effective communication.
5. In Section II, clearly state the reason for referral. This helps streamline the assessment process.
6. Provide any provisional diagnosis and pertinent history in Section III to give context to the referral.
7. If applicable, detail any previous assessments or treatments in Section IV for comprehensive understanding.
8. Once completed, you can easily save and share your form directly from our platform for free.

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