Please CLICK HERE to download and print our Referral Form, which can be faxed to us at 250-598-4013 or emailed at drnagy@shaw.ca

To fill out the form electronically, you will need to to download Adobe Reader (a free application). You can do so here. Once Adobe Reader is downloaded, please open the form with the application and you will be able to save the form after entering your information. If you open the form within a browser window (eg. Chrome, Firefox, Internet Explorer, etc.), the form cannot be saved as it depends on each individual’s browser settings.

Thank you for your referral. If you have any questions, please do not hesitate to contact us.