BCANDS Request For Services / Limits of Confidentiality and Release of Information Forms (Printable)

PRINTABLE REQUEST FOR DISABILITY SERVICES FORM

* For the text to voice option, on any page of the BCANDS website, simply highlight the text you wish to hear and click on the speaker icon!

In the event that you are unable to complete the online Request for Disability Case Management / Navigation services, please print the Request for Services PDF document below.

BCANDS Service Request / Limits of Confidentiality and Release of Information Forms

AdobeNote: you need adobe reader to view PDF files, click on the Adobe Reader button to download)

Please complete all areas, including the Limits of confidentiality document and fax to: BCANDS DCM at (250) 381 – 7343

or mail to:

Attention: BCANDS DCM                                                                                              #6 – 1610 Island Highway – Victoria, British Columbia – V9B 1H8

Thank you.