Pain Management Referral

Pain Management Program
St. Joseph’s Hospital
268 Grosvenor Street
London, Ontario N6A 4V2
Tel: 519-646-6019
Fax: 519-646-6292

Please note that all referrals must be completed on the form below. Please provide as much detail as possible to ensure your patient is triaged appropriately:

The Pain Management Program of St. Joseph’s Health Care London utilizes an interprofessional treatment service with an emphasis on building and supporting chronic pain self-management. Our goal is to develop a comprehensive treatment plan, work with our referring physicians to identify and address treatment challenges, and coordinate access to available community treatment resources and supports. Please provide us with as much information as possible and consider referrals to community agencies where appropriate to help us address potential treatment barriers. Please note that this referral form can only be submitted to our triage team once all required information on the form has been provided.