Skip to the content

Inclusion Health

Welcome to Inclusion Health, the trusted provider of comprehensive occupational therapy services in Surrey, White Rock, Langley, and Delta.

About Us
Blog
Careers
Contact Us
Cookie Policy
Home
Our Services
Patient Referral Form
Privacy Policy
Referral Form
Sample Page
Terms Of Service

Search for:

Patient Referral Form

Inclusion Health - Occupational Therapy Services in Surrey, Delta, Langley, White Rock

Please enable JavaScript in your browser to complete this form.

Patient Name *

First

Last

Patient's Phone Number *

Referrer Information *

First

Last

Phone Number

Reason for Referral *

Services For Kids (Pediatrics)
Assessment [Home/Work/School/Ergonomic]
Return to Work
Return to Function
Mobility/Seating
Disability/Case Management
ICBC Inquiry/Referral
Home Modification Assessment / BC Rebate for Accessible Home Adaptations
Ergonomic Assessment
Functional Capacity Evaluations
General Inquiry/Referral

Coverage

Private Insurance
No Coverage
ICBC
WCB
At Home Program Funding
Autism Funding
Variety Funding
CKNW Kids’ Fund
President’s Choice Children’s Charity

Claim/Policy/File#

© 2026 Inclusion Health