Chronic Pain – The Oscar Galaxy

NeuPath Centre for Pain & Spine Referral eForm 2025

John Robertson — Fri, 12 Dec 2025 05:39:18 +0000

Created for OSCAR BC at the request of NeuPath. Pain management clinics in Ontario. This eForm is protected by the GNU General Public License version 2 (GPLv2)

Arthritis & Musculoskeletal Pain / Back Pain / Cervicogenic Headache / Chronic Headaches / Complex Regional Pain Syndrome (CRPS) / Diabetic Neuropathic Pain / Fibromyalgia / Head and Neck Pain / Motor Vehicle or Work-Related Injuries / Myofascial Pain / Neuropathic Pain / Post-Shingles Neuropathic Pain / Post-Surgical Pain Syndromes / Shoulder and Arm Pain / Sports Injuries / Trigeminal Neuralgia /Whiplash Related Injuries

Please note: Fluoroscopic procedures available at Mississauga & Ottawa clinics.

Please complete all required fields to ensure timely triage. Attach any relevant diagnostic imaging (X-ray, MRI, CT) and recent consult notes if available. Select the preferred NeuPath clinic location from the list provided; if no preference is indicated, the referral will be directed to the nearest appropriate clinic.

GSH Medical Referral form for Chronic Pain

John Robertson — Tue, 03 Sep 2024 18:14:41 +0000

Created by David Price – Referral to GSH Medical for Chronic Pain.

JPOCSC Chronic Pain Clinic

John Robertson — Sun, 21 Jul 2024 17:59:24 +0000

This eForm was created at the request of Sardis Family Practice and the Chilliwack Division of Family Practice. It is a referral form to The Jimmy Pattison Outpatient Care and Surgery Centre – Chronic Pain Clinic. The first two pages are for the Physician to fill. The last 2 pages are for the patient to fill. Because of peculiarities about the drawing code, the order of the first 2 pages is reversed (if anyone knows how to modify the drawing code to draw on subsequent pages in a multi page eForm I would be interested to learn). In the patient forms there are questions about the GAD7, PHQ9, TSK, and PCS questionnaires. All but the PCS are linked in the form.

This eForm is protected by the GNU General Public License version 2 (GPLv2)

Lions Gate Hospital Rapid Access Spinal Clinic (RASC) Referral Form 2023

John Robertson — Fri, 27 Jan 2023 19:09:32 +0000

Referral to the Rapid Access Spinal Clinic at Lions Gate Hospital. Previously created in 2020. Old eForm removed and new eForm posted. Incorporates the new xBox code as of 2023/01/27. This eForm is protected by the GNU General Public License version 2 (GPLv2). You may copy and distribute verbatim copies of the Program’s source code as you receive it, in any medium, provided that you conspicuously and appropriately publish on each copy an appropriate copyright notice and disclaimer of warranty; keep intact all the notices that refer to this License and to the absence of any warranty; and give any other recipients of the Program a copy of this License along with the Program.

Painscape Standardized Case Management Referral

John Robertson — Sun, 04 Dec 2022 21:42:35 +0000

Created at the request of Dr. Petrus Retief. Referral for Acute and Chronic Pain management. Latest version corrects a coding error that linked to X boxes. Also has the ability to copy the fax number to the clipboard or to use the built in faxcontrol for those that have it.

Helmcken Pain Clinic Victoria BC

John Robertson — Tue, 15 Feb 2022 23:06:52 +0000

Referral to the Helmcken Pain Clinic created by Audrey Jones.

CADTH Non-drug Treatment form

John Robertson — Sun, 05 Sep 2021 23:31:46 +0000

2021-Sep-06 11:35 Updated to add and improve links. There is a link to the BC CBT referral form. Please feel free to 1) ignore this if you are outside of BC or 2) edit it to fit your location.

Update 2021-Sep-05 20:42 – now in 1 or 2 page forms. 2 page form allows printing of both pages with 1 click. One page form has hyperlink to the instructions page – smaller footprint on the screen, but need to use CTRL+P to print the instructions page.

Canadian Agency for Drugs and Technologies in Health Non Drug Treatment eForm. CADTH completed a series of evidence reviews to appraise and summarize the research on the effectiveness of non-drug
methods for the treatment of chronic, non-cancer pain. These reviews were used to develop a series of printable patient handouts and clinician evidence summaries, which can be found at cadth.ca/chronicpain. Clinician summaries include “practical considerations,” which are useful tips and strategies for recommending the use of each non-drug method to patients.