Access Peer Support for a Colleague

To refer a colleague to the Peer Support Program, please fill out the form below. The  information you share with us will be kept confidential – only viewable by the Peer Supporter and program administrator for the purpose of facilitating a match. The Peer Supporter will reach out to your colleague as soon as possible. Please ensure you have your colleague’s permission prior to filling out the form. If you have any questions, please contact support@vernonmsa.ca..

Confidentiality

The peer support program is structured to ensure privacy and does not report to any VJH department. Any information submitted through this website will be kept confidential (only viewable by the Peer Supporter and program administrator for the purpose of facilitating a match).

Name
Permission
Name
Reason for referral