Pain Clinics

All referral forms on this website are also available as eForms for OSCAR, Avaros, Indivicare, and ACCURO EMRs. You can download some of the premade forms here from WorldEMR or fill the contact form below for any other eForms that are not listed for your EMR.

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Pain Clinic – SJHC1. Pain Management (Over 18 yo only)St. Joseph’s Healthcare CentreSJHC Pain Clinic Online Referral
SJHC Pain Clinic
SJHC Pain Clinic Physician Agreement
Phone: 519-646-6019
Fax: 519-646-6292
Fax consult
Must have Family MD willing to follow after discharge from pain program
InMedic Pain Management1. Chronic Pain Management
2. Nerve Blocks
3. Lidocaine Infusions
4. Pharmacotherapy
5. Counselling
685 Adelaide St. N.
London, ON
N5Y 2L4
InMedic Online Referral
InMedic Pain Referral
Phone: 519-601-7171
Fax: 519-601-7174
Fax consult
Neupath Centre for Pain & Spine London (previously called CPM)1. Chronic Pain Management
2. Nerve Blocks
3. Botox Injections
4. Medication Management
215 Fanshawe Park Road West Suite #203
London, ON
N6G 5A9
Neupath Referral FormPhone: 519-434-4727
Fax: 519-434-4700
Fax consult
Pediatric Chronic Pain Program1. Pediatric Chronic Pain ManagementChildren’s Hospital London Health Sciences CentrePediatric Chronic Pain Referral
Pediatric Chronic Pain Referral Guidelines
Phone: 519-685-8500, ext. 57920
Fax: 519-685-8431
Fax consult
Alexandra Hospital Pain Management Clinic
Dr. Kamath, Vranda
1. Chronic Pain ManagementAlexandra Hospital
29 Noxon St
Ingersoll, ON
N5C 3V6
Generic FormPhone: 519-485-1700 ext 8272
Fax: 519-485-9606
Fax consult
Woodstock Pain Clinic
Dr. George, William
1. Chronic Pain ManagementWoodstock HospitalGeneric FormPhone: 519-539-1526
Fax: 519-539-7508
Fax consult
Primepoint Pain Clinic1. Chronic non-cancer Pain Management
2. Interventional procedures (nerve blocks, joint injections)
3. Platelet Rich Plasma (PRP) Injections
19 Elgin St
St. Thomas, ON N5R 3L7
Generic FormPhone: 519-207-7701
Fax: 519-207-7711
Email: [email protected]
Fax consult

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