Appointments are made only by referrals:
For Patients and physicians:
In order to process an appointment in a timely manner, we will need to receive the following information:
1- Referral form filled and signed by the referring physician.
2- Preliminary pain questionnaire filled, signed, and dated by the patient (Download: Fillable PDF)
3- Recent History & Physical
4- Recent medication list (from your pharmacist)
5- Copies of any recent blood work (CBC, kidney, and liver functions).
6- Copies of MRI, CT, and/ or ultrasound reports related to the painful part (Lumbar spine, C-spine, Knee, Hip, or Shoulder joints)
Physicians
For Physicians’ offices, please use this referral form and email to: [email protected] or fax it to 519-744-2611.
Patients:
Please make sure you indicate the best phone number, that you could be reached at (see patient questionnaire form, at the top)
Please send this information by e-mail at: [email protected] (scan and email documents)
Once we receive your full information package we will be in touch within 48-72 hours.
We look forwards to seeing you at SWOPI.
| Physicians | Patients |
|---|---|
| Referral Form (PDF) | Pain Questionnaire (PDF) |