Referral forms

Click below to download forms:




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