Referral forms

Click below to download forms:

 

[su_list icon=”icon: hand-o-right”]

  • EMG Referral form     [su_button url=”https://southlandemg.com/wp-content/uploads/2024/04/EMG-referral-2023V3.0.pdf” background=”#eb2b37″ text_shadow=”0px 0px 0px #000000″ desc=”Referral Form”]EMG[/su_button]

 

[su_list icon=”icon: hand-o-right”]

  • Ultrasound Assessment and Injection Referral form     [su_button url=”https://southlandemg.com/wp-content/uploads/2018/01/US-referral-2017V2.0.pdf” background=”#cb27b8″ text_shadow=”0px 0px 0px #000000″ desc=”Referral Form”]Ultrasound[/su_button]

[/su_list]

 

We accept referrals from family physicians, specialists and nurse practitioners, physiotherapists and occupational therapists. Please fill out the referral form above and send by fax to Southland EMG, Fax: (587) 481-7877. A consultation will be provided with an EMG assessment.

 

Current wait-times:

  • EMG/NCS evaluation: one to two months
  • Ultrasound guided assessment and peripheral injection: two to three weeks