BCANDS On-Line Client Service Request 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!

BCANDS is pleased to offer this on-line service request form for your convenience.

* Please Note: Once you have completed the form and pressed the “submit” button, the webpage will automatically default to the top. Once this occurs, please scroll down the page to ensure that there were no error messages or missing information required for submission. In the event that there is information still required, simply fill in the required field(s) and when completed press submit again, and then scrolling down once again to ensure submission.

Please use this form if you are requesting Disability Case Management / RDSP Services.

Who's Completing This Form?

If you are requesting services for yourself, please go to the next question. If you are completing this for someone else, please provide your name, contact information and relationship to the individual.

Full Name (First Middle & Last)(Required)

Please provide your full legal name as it appears on your government issued identification. You can also include your traditional name, if applicable.

How Do You Want Us To Address You?

If you would prefer we address you by a name other than that on your government issued identification, please indicate here.

Mailing Address(Required)

Please provide your full mailing address. This includes your street and house/apartment number, city or town and your postal code.

First Nation or Non-First Nation Community(Required)

Please click on the drop down menu and indicate if reside in a First Nation or non-First Nation community.

Telephone / Email(Required)

If you have, please provide a contact telephone number and email you can be reached at or if not please indicate N/A in the text box.

Indigenous Ancestry(Required)

Please click on the drop down menu and indicate if you are First Nation, Metis or Inuit.

Preferred Gender(Required)

Please click on the drop down menu and indicate the gender you identify as.

My Disability Condition(s)(Required)

Please briefly outline your disability condition(s) so that we can have a better understanding of you and your disability related needs.

Requested IDC/BCANDS Disability Services(Required)

Please briefly outline how IDC/BCANDS can assist you as it relates to your disability.

Thank you!