Refer a Patient

If your hospital does not have a formal agreement in place for After Stroke, use this community referral form. This form is also used for self-referral, and referrals by family and friends, local health providers, and community agencies.

    Primary contact information

    Referral source information

    * Reminder to provide us with your email if that is your preferred method of contact.


    Printable versions of the online form are available and can be downloaded for British Columbia and for the rest of Canada. Complete and return the form using the instructions included at the bottom of the form.