Referral Forms

Source: VIHA

Referral Forms for Health Professionals

The following Referral Forms are frequently requested by health professionals. Please note: These forms are intended for use by health professionals only. All forms are VIHA-wide and in PDF format unless otherwise indicated. Heart Function Clinic Cardiac Rehab/Risk Reduction and Heart Function Clinic Referral Form Echocardiography Request for Exam Form (Note: this form is for South Island Inpatients only). Kidney Care Clinic Kidney Care Clinic Referral Form Mental Health and Addiction Services Mental Health Intake Referral Form (Note: this form is for Physician use only, and refers to South Island services only). Application for Psychiatric Medication Coverage (BC Ministry of Health)