Nurse Recommends

This form is designed to give a nurse an initial idea of what plan of care may be most suitable for your needs. Please note that the final care plan can only be created after an initial assessment.

If you prefer to complete a shorter form, please visit our Services page for a detailed description. Alternatively, new clients may book a discovery call with a nurse.

This form cannot be used for emergency questions. Nursing services are available to residents of British Columbia only. If you are not a BC resident, you may access health advice from a health coach, subject to provincial tax.

I acknowledge that certain personal information will be collected and consent to its collection, use, and disclosure in accordance with the Privacy Policy of Vital Life Nursing.

Your Personal Information

First name

Last name

Contact Phone #

Please make sure to leave a valid phone number if you would like to schedule a callback.

Contact email address

Please leave a valid email address if you would like to receive nursing recommendations.

Which option do you prefer for receiving nursing recommendations?

Phone call

None

Person requiring services

Name of the person requiring Care (Healthcare services)

Number

Address (country and city only)

Is a person requiring care aware and agree to receive healthcare services

Sometimes people need thorough preparation and explanation about the assistance they can receive, even if they are hesitant at first.