COMMUNITY SUPPORT INTAKE FORM

Please use this form to submit a referral to Pender Islands Health Centre’s Better at Home and Social Prescribing programs on Pender Island. A Program Coordinator will reach out to you as soon as possible. If you have any questions about this form or the referral process, please contact our Better at Home or Community Connector program coordinator.

COMMUNITY SUPPORT SERVICES

Assessment/triaging

Caregiver relief

Co-creation of wellness plan

Counselling/peer support

Deep Cleaning

Digital literacy / tech support

Errands

Exercise classes

Group Activities

Follow-up/check in

Friendly Visiting

Garbage and Recycling

Grocery shopping/services

Health System Navigation

Light Housekeeping

Light yard work

Meal delivery

Minor home repairs

Prepared meal delivery

Prescription pick-up/drop-off

Resources and Referrals

Shared meals

Snow removal

Social Events

Transportation medical

Transportation non-medical

Wellness Plan

Wood chopping