Patient Referral Form
Referral Inquiries
We are ready to contact your patient once we receive your referral. Either complete the form below online or download the referral form.
If you need assistance or would like to talk to us during regular business hours please call 1-250-667-7722.
Patient Referral Form
If you prefer to fill out a physical copy of this form, download a PDF copy of our patient referral form and return via email or fax.
PLEASE ADVISE PATIENTS:
- Bring a list of all current medications to the appointment.
- On site free parking is available.
- Arrive at least 10 minutes prior to the appointment to fill out a short questionnaire and sign consent.
- You will be notified with the date and time of your patient’s appointment. Your patient will be informed as well.
- Please provide at least 48 hours notice for any cancellations or changes to appointment times.
Email the clinic at clinic@breathcontrol.ca or call 1 (250) 667-7722.
1 (250) 667-7722
2850 Glenayr Drive
Nanaimo, BC V9S 3S6