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RÉSULTATS DE LA RECHERCHE

Centralized Mental Health and Addiction Services Referral Form

Form # DRAFT 1 of 2| P a g e...Form created 08/2018...Centralized Mental Health & Addiction Services...Referral...FAX to 905-631-0513...PLEASE NOTE: Community Mental Health & Addiction Services are NOT...
http://www.lignesantehnhb.ca/pdfs/Centralized%20Mental%20Health%20and%20Addiction%20Services%20Referral%20Form.pdf

Maternity Centre of Hamilton Referral Form

Patient Name Referring Physician...Address...Ref. ...MD Phone #...Phone #...Ref. ...MD Fax #...Health Card #...DOB...Language spoken if...other than English...It is the patient’s responsibility to...
http://www.lignesantehnhb.ca/pdfs/Maternity%20Centre%20of%20Hamilton%20Referral%20Form.pdf

Seniors for Seniors Brochure

• Companionship through friendly drop-in visits...• Live-in, 24/7 care...• Overnight stays to keep loved ones safe...• Bedside companionship at hospitals and...care facilities...• Alzheimer’s and...
http://www.lignesantehnhb.ca/pdfs/Seniors%20for%20Seniors%20Brochure.pdf

Prenatal Diagnosis Clinic Referral Form

Genetic Counselling Inquiries 905-521-2100 ext 76247...Clinic Bookings 905-521-2100 ext 73135...Fax 905-521-4955...2F Prenatal Diagnosis Clinic...1200 Main St. ...West, Hamilton ON L8N 3Z5...Physicians...
http://www.lignesantehnhb.ca/pdfs/Prenatal%20Diagnosis%20Clinic%20Referral%20Form.pdf

Brant Nutrition Brochure

INTUITIVE EATING PROGRAM...Initial Assessment &...5 Follow ups……………………………..….$550...INDIVIDUAL COUNSELLING...COUPLES COUNSELLJNG...FAMILY COUNSELLING...01...Initial Assessment………………………$185...Follow...
http://www.lignesantehnhb.ca/pdfs/Brant_Nutrition_Brochure.pdf

Utility Grant Program Brochure

Port Cares Utility Grant Program...Guidelines...The Utility Grant Program is designed to help people who are experiencing an emergency in...paying their utility bills. ...The Program may be able to help...
http://www.lignesantehnhb.ca/pdfs/Utility%20Grant%20Program%20Brochure.pdf

Wesley Hoarding Outreach Team Referral Form

Wesley Hoarding Outreach Team Referral Form...Client Information...Date: Client Name:...Address: Phone:...D.O.B: Main Language at Home:...Client/Self-Identified Gender:...Consent Obtained:...Yes □ No...1...
http://www.lignesantehnhb.ca/pdfs/Wesley%20Hoarding%20Outreach%20Team%20Referral%20Form.pdf

COAST Referral - Brantford

COAST Referral Date (yyyy-mm-dd):______________________...Name: (First, Last, Middle)...DOB(yyyy-mm-dd)...Address...City...Phone:...Alternate:...Next of Kin:...Next of Kin #:...Referral Source...Name...
http://www.lignesantehnhb.ca/pdfs/COAST%20Referral%20-%20Brantford.pdf

Hepatitis C Care Clinc Referral Form

Hepatitis C Care Clinic...Port Colborne General Site / New Port Centre...Port Colborne, ON L3K 2N7...Phone: (905) 378-4647 Ext. ...32554...Confidential Fax: (905) 834-6014...Main Clinic Satelitte Clinic
http://www.lignesantehnhb.ca/pdfs/Hepatitis%20C%20Care%20Clinic%20Referral%20Form.pdf

Chapel Heights Respite Recovery Health Care Patient Card

7373 Niagara Square Drive, Niagara Falls, Ontario L2H 1J2...905.371.0121 • contact@chapelheights.ca...www.chapelheights.ca...NEED A RESPITE...OR RECOVERY STAY?...ENHANCED CARE...& RECOVERY...☛ 24 Hour
http://www.lignesantehnhb.ca/pdfs/Chapel%20Heights%20Respite%20Recovery%20Health%20Care%20Patient%20Card.pdf