Download the above referral form, and fax to 604 566 9102
Referral Acceptance Criteria
For All Programs
- Patient has non-cancer pain that has not resolved on its own or with conventional therapies within 3 months of onset.
- Patient and/or Caregiver:
- Completes the online Intake Questionnaire. We only accept patients unless they complete this step.
- Are cognitively capable and willing to participate with the recommended plan, including Group Medical Visits
- Are willing to complete Pain Related Questionnaires at the 1st consultation and every 5th visit.
For the iSITES Program
- For referrals direct to iSITES, the referrer should be confident that the patient could benefit from specific pain blocks, otherwise please refer to our Core Program for specialist assessment.
- Note – Core Program Patients will be internally referred to iSITES where appropriate
For Infusion Therapy Program
- Patient must be screened by one of our Infusion Anesthesiologists to ensure the procedure is safe for them.
We DO NOT accept
- Patients who live outside of the Vancouver area, except for Pain Infusion Therapy. Please see our catchment area below.
- Active WorkSafe BC patients, unless Worksafe BC has confirmed whether or not they will cover CHANGEpain services
- Pregnant patients (for procedures)
- Patients without a Primary Care Physician or regularly attended Walk-In Clinic, if they need medication as part of their recommended treatment program. We do not prescribe at CHANGEpain, and instead provide medication recommendations to Primary Care Physicians.
- Patients that cannot understand English and do not have a translator available.
- For safety reasons, we do not accept patients to the iSITES or Pain Infusion Therapies if they:
- Have severe mobility restrictions
- Weigh more than 275 lbs.
- Cannot lie in prone position (iSITES only)
- Have allergies to medications needed for the treatment
- Have MRSA or cellulitis
We recommend hospital based treatment for these patients.
CHANGEpain’s Catchment Area
We currently accept patients from the following areas:
- North Vancouver
- West Vancouver
- New west
- Port Coquitlam
- Port Moody
Please note that list is subject to change.
We recommend patients living on Vancouver Island be referred to Island Health’s Regional Outpatient Pain Management Program or The myoClinic
Required Intake Survey
Due to the very high volume of referrals we receive, we are increasing the use of technology to help streamline our processes and introducing new referral acceptance criteria.
CHANGEpain requires all patients to electronically complete an information questionnaire BEFORE setting up a consultation.
We prefer that you provide a patient email address as part of your referral. We use email to send the patient a link to a mandatory (and secure) online questionnaire which we can upload directly to our EMR.
Patients who do not have an email or are uncomfortable submitting information online may come into our office to complete the questionnaire on our patient computers. Patients that are not able to use a computer are welcome to have a trusted family member, friend, or caregiver complete the information for them.
Surveys must be completed within 30 days or the referral will be returned.
We will arrange appointments with patients directly after we receive a physician referral AND the patient has completed our intake questionnaire.
How to Refer:
Please fax a referral with the following information:
Patient demographic information (name, PHN, DOB, address, phone, and email)
- A brief description of the pain problem (painful areas, muscles, range of motion, gait etc.)
- Relevant patient history summary.
- For more complex pain patients please include any relevant specialist consultation reports, imaging, labs and medication information.
- Treatment Goals
Put through a no-charge referral 3333 to MSP billing # 26194 – Dr. Brenda Lau.
(Dr. Lau receives all referrals on behalf of CHANGEpain. We will forward the referral to the CHANGEpain consulting physician as appropriate.)
We will send the referrer an acknowledgement by fax to confirm we received the referral.
The treating physician will send the referrer a detailed consultation letter after completion of the first consultation, after approximately 6 months of treatment, and on discharge.