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.
Clinic | Services | Location | Form | Contact | Information |
---|---|---|---|---|---|
Pain Clinic – SJHC | 1. Pain Management (Over 18 yo only) | St. Joseph’s Healthcare Centre | SJHC Pain Clinic Online Referral SJHC Pain Clinic SJHC Pain Clinic Physician Agreement | Phone: 519-646-6019 Fax: 519-646-6376 | Fax consult Must have Family MD willing to follow after discharge from pain program Website |
InMedic Pain Management | 1. 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 Website |
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 Form | Phone: 519-434-4727 Fax: 519-434-4700 | Fax consult Website |
Pediatric Chronic Pain Program | 1. Pediatric Chronic Pain Management | Children’s Hospital London Health Sciences Centre | Pediatric Chronic Pain Referral Pediatric Chronic Pain Referral Guidelines | Phone: 519-685-8500, ext. 57920 Fax: 519-685-8431 | Fax consult Website |
Alexandra Hospital Pain Management Clinic Dr. Kamath, Vranda | 1. Chronic Pain Management | Alexandra Hospital 29 Noxon St Ingersoll, ON N5C 3V6 | Generic Form | Phone: 519-485-1700 ext 8272 Fax: 519-485-9606 | Fax consult |
Woodstock Pain Clinic Dr. George, William | 1. Chronic Pain Management | Woodstock Hospital | Generic Form | Phone: 519-539-1526 Fax: 519-539-7508 | Fax consult |
Primepoint Pain Clinic | 1. 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 Form | Phone: 519-207-7701 Fax: 519-207-7711 Email: [email protected] | Fax consult |
Need eForms for your EMR system? EMR training? IT services? Online booking? Check-in kiosk? Contact us
Get all the London-area eForms for OSCAR, JUNO, Avaros, THT, Indivicare here
Contact [email protected] for any other eForm needs for OSCAR, JUNO, Avaros, THT, Indivicare, and Accuro EMRs.