Referrals

If you think Ataraxia Pain Management Clinic is right for you, please download a copy of our referral form and pre-consult pain questionnaire.

Ataraxia Referral Form (For Physician To Complete)

Atarxia Pre-Consult Pain Questionnaire

  • Ask your doctor to complete our Ataraxia Referral Form. After we have received this form we will then review it. You will receive a call for an appointment booking only after we receive the form.
  • Complete the Ataraxia Pre-Consult Pain Questionnaire. Print out the Pain Questionnaire and fill it out prior to your appointment. You can either fax the form over prior, or you can bring it with you to your appointment.

It is important to bring all documentation to your appointments so that we have a better understanding of your condition. Please bring any relevant medical notes, images, a list of any current medications, and any documentation that we would need to better understand your needs.

Once completed and signed, all forms can be submitted by fax to 416-221-0585.

Chronic Pain Management Services

Our medical procedures are used to assist you in your recovery. Our procedures receive the highest standards of care and are thought out for the purpose of taking back control of your life. Our services include, but are not limited to:

  • Intravenous Infusions (Lidocaine/Ketamine) for neuropathic pain
  • Radiofrequency Neurotomy for facet joint pain or sacroiliac joint pain caused by arthritis, other degenerative changes, or from an injury.
  • Sacroiliac Joint Injections (for diagnostic as well as therapeutic purposes)
  • Diagnostic Nerve Blocks
  • Stellate Ganglion Blocks
  • Lumbar Sympathetic Nerve Blocks
  • Peripheral Nerve Blocks (Guided Blocks)
  • Epidural Steroid Injections– for back and neck pain, sciatica and radiculopathy (conditions due to compressed nerves)
  • Facet Medial Branch Blocks
  • Therapeutic Botox Injections – used for chronic migraines, hyperhidrosis, back/nerve pain and muscular spasticity (muscle stiffness/tightness).
  • PRP (Platelet Rich Plasma), used for:
    • Osteoarthritis of the knee, shoulder, hip and spine
    • Rotator cuff tears
    • ACL injuries
    • Pelvic Pain and Instability
    • Back and neck injuries
    • Tendonitis and ligament sprains
    • And more
  • Stem Cell Therapy
  • Prolotherapy
  • Pharmacotherapy
  • Remicade Intravenous for rheumatoid arthritis, psoriatic arthritis and certain bowel diseases (Crohn’s Disease, Ulcerative Colitis)