Healthcare Seeker
Are you making a referral?*
Enter your information.
*so that we can let you know when the referral has been completed
I have spoken to the patient/client above and they have agreed for me to fill out this Connect2Care form on their behalf. Patient/client and I both understand that this is only for purposes of communication with ICAN!, myself and the selected health center. Text/Emails are sent to make sure the patient/client can get their contraception of choice without barriers.
Referral Consent