Get Client Referral Form Final - Seniors Services

Filling out the Client Referral Form for Seniors Services is a crucial step in connecting individuals aged 55 and older with supportive housing services. This guide will provide step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the Client Referral Form online.

1. Click ‘Get Form’ button to obtain the form and access it for completion.
2. Provide the client's name and age in the appropriate fields. Indicate whether the client is 'Homeless' or 'At Risk' by selecting the relevant option.
3. In the Referrer Information section, enter today’s date, your name, your agency, and your contact information. Add your relationship to the client.
4. Fill out the Client Information section starting with the client's full name, date of birth in the format of dd/mm/yyyy, and contact numbers. Indicate the client's residency duration in British Columbia.
5. Choose the client's preferred language and indicate if a translator is needed. Then, provide the monthly gross income and detail any additional income sources.
6. Indicate if the client is on income assistance and specify their employment status by selecting from the provided options.
7. Only complete one of the following sections: if the client is 'Homeless', indicate when they became homeless, provide their sleeping arrangements, and detail the reason for homelessness.
8. If the client is 'At Risk', enter their monthly rent, landlord's contact information, and the reason they need to leave their current housing.
9. Add information about the desired permanent housing, preferred areas, and any assistance the client may need to live independently.
10. Document any special considerations such as pets, smoking, or wheelchair access. Include other relevant information as necessary.
11. In the Medical Contacts section, list the names and phone numbers of any relevant medical professionals, and note any physical or mental health issues.
12. If the client is currently in hospital, complete the hospital section with the name, admission date, discharge date, and reason for admission.
13. Complete the Release of Information form carefully to ensure confidentiality and authorize the sharing of necessary information for service provision.
14. Once all sections are filled out, save your changes, and options to download, print, or share the form will be available.

Start filling out the Client Referral Form online today to help connect seniors with essential services.