Use this option if you prefer to fill out a referral form, provide it to the client, and have them contact us directly to set up the appointment and/or if the client does not have access to email. This form can also be used if you require your client to sign a consent form in your office before you are able to refer them
If the client does not have access to email, please provide them with a
completed copy of this form and ask them to contact us directly at (250)472‐9327 to set up an
appointment by letting us know that they have been referred by your agency.
Referral to the Wear2Start program
250-472-9327 (Please leave a voicemail as we may be with a client.)
Send any referral emails to email@example.com and put “Wear2Start Appointment Request” in the subject line.
By appointment only.