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11355 105 Ave., Edmonton AB T5H 3Y3 PH: 8252224816 Fax: 833.381.0920 HealthandWellnessEDM@theseed.caHealth and Wellness Referral Form *Please complete and fax form to 833.381.0920Date: Referral Source:

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How to fill out health and wellness referral

01

Obtain a health and wellness referral form from your healthcare provider.

02

Fill out your personal information including name, date of birth, contact information, and insurance details.

03

Provide information about your medical history, current health concerns, and any medications you are taking.

04

Specify the reason for seeking the referral and the type of services you are requesting.

05

Sign and date the form before submitting it back to your healthcare provider.

Who needs health and wellness referral?

01

Individuals who have been advised by their healthcare provider to seek additional health and wellness services.

02

People who are looking to access specialized care or treatments that require a referral from a healthcare professional.

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What is health and wellness referral?

Health and wellness referral is a process where an individual is directed to health and wellness programs or services based on their healthcare needs.

Who is required to file health and wellness referral?

Healthcare providers such as doctors, nurses, or case managers are typically required to file health and wellness referrals for their patients.

How to fill out health and wellness referral?

Health and wellness referrals can be filled out by providing relevant information about the patient's healthcare needs and selecting appropriate programs or services.

What is the purpose of health and wellness referral?

The purpose of health and wellness referral is to ensure that individuals receive the necessary healthcare services or programs to address their specific needs and improve their overall well-being.

What information must be reported on health and wellness referral?

Information such as the patient's medical history, current health status, healthcare needs, and recommended programs or services must be reported on health and wellness referral.

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