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 416-519-1210.