Get Client Referral Form Final.doc

This guide provides clear and detailed instructions on how to complete the Client Referral Form FINAL.doc online. Designed for users seeking assistance for seniors who are homeless or at risk of homelessness, this guide will support you through each section of the form.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the client's name and age at the top of the form. Indicate whether the client is homeless or at risk of homelessness 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 the client information section. Fill out the basic info fields including the client's full name, date of birth (DOB), contact number, and residency status in BC. Indicate the preferred language and whether a translator is needed.
5. In the income section, provide the client's monthly gross income before deductions. Include any other sources of income and specify if the client is on income assistance, selecting the relevant checkbox.
6. Complete either the homeless section or the at-risk section, but not both. In the homeless section, note when the client became homeless, their sleeping location, reason for homelessness, and current type of housing including address and contact information.
7. Alternatively, in the at-risk section, provide the monthly rent and landlord or building manager's contact details. Describe why the client must leave their current housing and where they would like to live permanently.
8. In the medical contacts section, fill in the names and phone numbers of relevant medical personnel. Provide details about any physical and mental health issues, and history of substance abuse if applicable.
9. If the client is currently in the hospital, complete the hospital section with the hospital name, admission and discharge dates, the reason for admission, and contact information.
10. Make sure to review all provided information for accuracy. Once completed, users can save changes, download, print, or share the form as necessary. Ensure to store a copy for your records.

Begin completing the Client Referral Form online today for efficient submission.