Client Referral Form FINAL - Seniors Services 2026

1. Click ‘Get Form’ to open the Client Referral Form FINAL - Seniors Services in the editor.
2. Begin by filling out the 'Client’s Name' and 'Age' fields. Indicate if the client is 'Homeless' or 'At Risk' by selecting the appropriate checkbox.
3. In the 'Referrer Information' section, enter today’s date, your name, agency, contact information, and your relationship to the client.
4. Proceed to 'Client Information'. Fill in the client's full name, date of birth (DOB), contact numbers, and residency status in BC. Specify their preferred language and whether a translator is needed.
5. Complete the income section by entering the monthly gross income and any other income sources. Indicate if the client is on income assistance and select their employment status.
6. Choose either the 'Homeless' or 'At Risk' section to complete. For 'Homeless', provide details such as how long they have been homeless, current sleeping arrangements, and reasons for homelessness.
7. For those at risk of homelessness, fill in their current rent amount, landlord's contact information, reasons for leaving current housing, and desired permanent housing details.
8. Lastly, include any medical contacts and relevant health issues before signing off on the Release of Information form at the end of the document.

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