A revised MHSU intake referral form for patients 19+ will help improve patient information for referral to psychiatric assessment and/or other Island Health MHSU services. South Island Division of Family Practice physicians, psychiatrists and Island Health collaborated on the revision.

Major changes:
1. Inclusion of sex/gender spectrum options
2. Space for clinic sticker
3. Inclusion of non-urgent, semi-urgent, and urgent options
4. Both check boxes and text space to describe symptoms
5. Text space for referring physician’s suspected diagnosis and (if known) type of MHSU support service seeking
6. Patient collateral form to be filled out by the patient or their caregiver

The form is laid out in an intuitive manner to capture MHSU patient information for efficient and effective referral.

• View the MHSU intake referral form
• View the MHSU patient collateral form

Both forms can also be found on Pathways

• MHSU intake referral form, full link name: Mental Health & Substance Use (MHSU) Intake Fillable Referral/Patient Collateral Form – Victoria / Westshore CARES 
• MHSU patient collateral form, full link name: Mental Health & Substance Use (MHSU) Fillable Patient Collateral Form Only – Victoria / Westshore CARES,

and on the Island Health website, full link name: Referrals Victoria Mental Health & Substance Use | Island Health.