Mandatory Fields
Overview

Information you provide in this form is to assess and investigate a report about the alleged abuse, neglect or self-neglect of an adult who may be vulnerable.

This form requires you to provide your name, phone number and relationship with the adult you are concerned about. Your identity is protected from disclosure by law. If you have any questions please contact our Assessments and Investigations department at 1-877-511-4111.

Information is collected under the Freedom of Information and Protection of Privacy Act (FOIPPA) and other applicable legislation. If you have any questions about the collection, use or disclosure of information, contact the PGT’s Information and Privacy Officer at 604-660-4444 or mail@trustee.bc.ca.

The adult’s personal information
The following identification details help us to investigate the adult's situation, and investigate and identify their income and assets. Please provide as much information as possible.
Please share any name(s) that this person may use that is not their legal name.
Date of birth known?
Is the adult Indigenous?
The PGT can arrange for an interpreter to support this referral if the adult’s primary language is not English.
The Personal health number is a 10-digit number. Do not include dashes, spaces, or letters.
The Social Insurance Number is an 9-digit number. Do not include dashes or spaces.
Is the adult a veteran?
Is the adult receiving Department of Veteran Affairs benefits?
Current location of the adult
A facility includes a group home, mental health care facility, care facility, and assisted living.
Primary residence
Reason for the referral
Understanding the adult's situation helps us conduct an effective, timely investigation. Please provide us with the following information regarding risk to income and assets or potential legal matters.
Do any of the adult’s assets require urgent protection?
Assets may need urgent protection when there is evidence that they have been or are at risk of being stolen or used fraudulently.
Is the adult aware of this referral?
People in the adult’s life
Please provide details about people in the adult's life. Include their involvement in the adult's current situation. Information on each person helps us assess this referral.
You may enter up to 10 persons.
Person 1
Is this person Power of Attorney or Representative?
Is this person aware of this referral?
The adult’s medical information
Please provide details about the medical assistance the adult is receiving and any related service provider's contact information that you have.
The adult is assisted by the following:
For example, physician, social worker, nurse.
Program and location
Provide details and contact information for any programs the adult may be involved in. (for example: home health, mental health, acquired brain injury)
Program 1
Is the adult assisted by Community Living BC?
Is this person being served by any physicians?
Physician 1
The adult’s financial information
Please provide details about the adult's finances.
Income sources, select all that apply:
Please list known financial institution information and account number and balance if known.
A financial institution is a company that deals with financial transactions, such as investments, loans, and deposits. Examples are banks, investment companies and credit unions.
Does the adult own real estate?
Is the property insured?
Supporting documents
Please attach any supporting documents related to the adult that you think will support this referral.
Attach any additional documents to support this referral

Document file types can be any and only these formats: .pdf, .doc, .docx, .xls, .xlsx, .rtf, .txt, .jpg, .jpeg, .tiff, .tif, .csv, or .png.

Each file must be under 25 MB, and the form has a 150 MB limit for all attachments.

Please do not password-protect files, as this will prevent the PGT's system from scanning for viruses. Files that cannot be checked for viruses will be securely deleted.

Referring party
Please provide your contact details so we can discuss your concerns in more detail. Your identity is protected from disclosure by law. If you have any questions, please get in touch with our Assessment and Investigations department at 1-877-511-4111.

Sections in this form

Download a copy of your referral for your records before you submit. You will not be able to save a copy of the form after you submit it.