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New Client Application Form - Sept 2023 -FINAL.pdf

Christanne Lewis...BQWCHC PHC-100 New Client Application Form NEW: Sept 2023...New Client Application Form...See page 2 for instructions...Applicant Information:...Last Name First Name...Preferred Name...
https://www.southeasthealthline.ca/pdfs/New%20Client%20Application%20Form%20-%20Sept%202023%20-FINAL.pdf

AMHS-KFLA Fillable Referral Form 2019

AMHS-KFLA...Southeast Ontario Addictions & Mental Health Services Access Form...AMHS-KFLA...This form is to be completed by Primary Health Care and other Health Services Providers...FIELDS MARKED WITH AN...
https://www.southeasthealthline.ca/pdfs/amhs-kfla_addictions_mental_health_kingston_referral_form.pdf

kfla_smoking_cessation_supports.pdf

Smoking Cessation Supports...in the KFL&A Region...Some pharmacists can prescribe medications and provide counselling....• If on ODSP, OW, under age 25, or age 65 and over, 12 weeks of...medications are...
https://www.southeasthealthline.ca/pdfs/kfla_smoking_cessation_supports.pdf

Centralized Referral Form

1-877-422-1112...Fax: 1-877-344-9962...referrals@sciontario.org...Client Disability (Please fill out as much as possible)...Spinal Cord Injury (SCI):...Non-SCI:...Complete SCI:...Incomplete SCI:...Date...
https://www.southeasthealthline.ca/pdfs/SCIO-centralized-referral-form.pdf

Community_Brain_Injury_Services_Referral_Form.pdf

pccctemplaw...P...E...R...S...O...N...L...H...E...L...T...H...N...F...O...R...M...T...IO...N...400745 (2019/05) SIDE 1 OF 2 PERSONAL HEALTH INFORMATION FORM...COMMUNITY BRAIN INJURY SERVICES (CBIS)...For...
https://www.southeasthealthline.ca/pdfs/Community_Brain_Injury_Services_Referral_Form.pdf

“APPLICATION TO REGISTER” For Health Services

Stroke Diabetes...COPD/Lung Problems Heart Attack...Heart Disease/Heart Surgery/Heart Valve/Heart Murmur/Pacemaker...Infective Endocarditis...Congenital Heart Disease (from birth)...Immune System...
https://www.southeasthealthline.ca/pdfs/BQWCHC_application_referral_form_oral_Health_Services.pdf