Pain Management Program: Referrals

A referral from your family doctor or a specialist is required to become a patient of St. Joseph’s Pain Management Program. Included in our screening criteria are:

  • The patient must have a family doctor willing to follow him/her after discharge from the pain program
  • We do not address chronic daily headaches and known fibromyalgia
  • Our program provides specialized care for individuals 18 years of age and older.

Referrals are triaged by a pain specialist. If our program fits your needs, you will receive an appointment to see one of the pain specialists within our program.

Please note: Due to the high number of referrals, there may be a wait period of up to eight months for non-urgent cases.

For Physicians:

Referral Process to St. Joseph's Pain Management Clinic

All referrals must be on our form as this makes it easier for the triage nurse to recognize if information is missing. The form is available below.

Diagnostic tests to be completed prior to acceptance of the referral:

  • All patients over 60 years old, OR with a history of significant malignancy OR with a history of radicular pain (pain radiating down one limb) must have a CT or MRI of the appropriate area within 18 months of the appointment.

Please attach:

  • Complete medication list, including Coumadin, Plavix, ASA, opioids.
  • All pertinent imaging (CT, MRI, Bone Scan).
  • All related consults from other physicians including surgical reports.

Once all the required information is received and the Physician Agreement (Word) letter has been signed by the primary care doctor, the triage nurse assigns a priority to the referral. After the triage assignment, the receptionist books an appointment and faxes notification to the referring doctor.

It is the responsibility of the doctor's office to ensure that the patient is aware of  both the mandatory orientation appointment as well as the appointment with the pain management physician. 

It is the responsibility of the patient to confirm both appointments one week in advance. Due to the high number of referrals and our wait times, appointments with physicians will be cancelled if they are not confirmed one week in advance.  Confirmation of the appointment can be left at 519 646-6019 ext.2 at any time of day.

Please complete the pain management referral form

Physician agreement letter

Last updated: Mon, 2018-01-08 12:24