Get Happy Hearts Plus Application With Physician's Referral Form

The Happy Hearts Plus Application With Physician's Referral Form is designed to facilitate enrollment in a community cardiac wellness program with medical supervision. This guide provides clear, step-by-step instructions for completing the form online to ensure a smooth application process.

Follow the steps to successfully complete the application form online.

1. Press the 'Get Form' button to access the Happy Hearts Plus Application With Physician's Referral Form and open it in your preferred editor.
2. Select the preferred community location from the available options: Kensington Community Centre, Jewish Community Centre, Dunbar Community Centre, or Robert Lee YMCA.
3. Fill in the date, last name, first name, address, telephone number, birthdate, Care Card number, and email address in the provided fields.
4. Enter the name of the family physician and the cardiologist associated with your care.
5. Indicate if you have previously attended a hospital cardiac rehabilitation program by selecting 'Yes' or 'No' and provide the location and graduation date if applicable.
6. Check any relevant medical history items such as heart attack, high blood pressure, high cholesterol, angina, bypass surgery, diabetes, or any other conditions that apply.
7. Ensure the physician completes the referral section, including their signature and the date, if applicable.
8. Once all fields are filled out, review the form for accuracy and completeness.
9. Save the form changes, then download, print, or share the form as needed, and ensure it is faxed to 604-875-5794 or delivered to your preferred community center.

Begin filling out the form online to take the first step towards your cardiac wellness!