Get Fraser Health Dietitian Referral Form

Filling out the Fraser Health Dietitian Referral Form online is a straightforward process designed to assist users in accessing nutritional counseling. This guide will provide clear, step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editing interface.
2. Begin by filling out the patient information section. Enter the first name and last name of the individual seeking counseling. Indicate the patient's gender by checking the appropriate box.
3. Next, provide the date of birth in the format of day/month/year. Include the Personal Health Number (PHN) for identification, as well as a contact number for both home and other relevant phone numbers.
4. Attach any recent lab results that may be required, such as renal indices, lipid profiles, or fasting blood sugar results. Ensure that these documents are included, as the referral may be returned if they are missing.
5. Fill in the patient's address to establish a point of contact. Following that, input the height and weight of the patient to provide context for dietary needs.
6. The physician's stamp is required for the form to be valid. Ensure the healthcare provider's signature and the date are included in this section.
7. Specify the primary reason for the referral by checking the relevant boxes, such as heart disease or diabetes. Additionally, include any related medical issues that should be considered.
8. Provide other pertinent information, including any medications or supplements the patient is currently taking.
9. After filling out all sections, review the form for accuracy. Once confirmed, you may save changes, download, print, or share the form as needed.

Start completing your referral form online to access dietitian services quickly and effectively.