Canuck Place referral forms for healthcare providers

Anyone can make a referral to Canuck Place on behalf of a child, including families and healthcare providers. 

We serve children ages 0-19. We also serve families in the prenatal stage whose fetus has been found to have a serious condition. The important factor for our program is the presence of a progressive, life-threatening condition. Progression meaning, on-going deterioration of health and/or functions.  Life-threatening means the “child” is likely to not live into full adulthood (defined as early 20’s). They may die either because of a progressive disease process or because of disease effects and complications.  Some children/youth are within slowly progressing phases of their conditions, while others are acutely terminal. 

Referral process

 If you believe a child is appropriate for our program, here are the steps to follows:

  1.  Call the Intake Nurse at Canuck Place Children’s Hospice, 604-742-3476 or toll-free in BC at 1-877-882-2288 ext. 3476. If the referral is urgent, please call the nursing station at 604-742-3475
  2. The Intake Nurse will follow-up on information from the child’s physician, care provider and parents
  3. This information is reviewed by the Intake Team at Canuck Place
  4.  If the child is eligible for the program, the parents/guardians are informed and advised of the programs available

All of Canuck Place’s services are available at no cost to families.

REFERRAL FORM

PERINATAL REFERRAL FORM