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Health Care Professional Referral Form

NOT AN EMERGENCY SERVICE

If you are referring a person who requires urgent care, please refer them directly to Comox Valley Hospital or other local emergency services

Seeking Support for Yourself or a Family Member?

If you are seeking support for yourself or someone in your family, you can self-refer:

Our Process & Services

Comox Valley Counselling offers mental health support for individuals, relationships, and families. Our therapists work from a person-centered approach to support individualized goals and well-being.

Areas of Support Include:

Anxiety & Depression | Grief & Loss | Substance Use | Trauma & Recovery | Interpersonal & Relationship Challenges

 

Turnaround Time

Individuals referred through this form will be contacted within 5 business days to schedule an initial appointment with one of our counsellors.

Billing & Insurance Information
  • Payment Type: Our services are private pay.

  • Direct Billing: Some of our counsellors offer direct billing to approved 3rd party funding sources (including FNHA, CVAP, ICBC, or private insurance). If the person being referred has 3rd party coverage, we will connect them with an approved counsellor.

  • Low-Cost Options: We also offer low-cost counselling through our intern program.

🔒 Privacy & Data Protection

We protect and handle personal health information in strict compliance with British Columbia’s Personal Information Protection Act (PIPA) and Freedom of Information and Protection of Privacy Act (FIPPA). We only collect information reasonably necessary to deliver our services.

CONTACT US

Health Care Professional Referral Form

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