Changepain

Referral for Procedure Only
Steps for sending Referrals for Procedure Only
For Doctors
  • Approximate wait-times for MSP-covered procedures is 1 month for procedures only
  • For private pay medical services, please contact our Private Pay Services Coordinator.
  1. Download the above referral form, and fax it to 604-566-9102 or email it to procedures@changepain.ca
  2. When we receive the referral form, we will send your office an acceptance letter and contact your patient with the appointment date and time.
  3. Mandatory information to include in the referral:
    • The patient’s email address and cell phone number are mandatory as these are our primary methods of communication. If the patient does not have an email, please have them complete the Proxy Access Consent form and fax it back along with the referral
    • Attach key consults and imaging reports within the last two years
    • Referring doctor sends a no-charge referral 3333 to MSP under Dr. Brenda Lau (#26194)
    • Note: Dr. Lau receives all referrals on behalf of all the changepain physicians.
  1. Important: Please provide all the mandatory information on the referral form as this reduces delay in scheduling.
Medical Services Acceptance Criteria
• Urgent Referrals (Additional to requirements for Non- Urgent Referrals)
  • Medically stable Cancer patients requiring urgent procedures
  • Urgent multidisciplinary team assessment (private pay only)
  • Patients with < 3 months onset radicular pain (radiologically plus clinically abnormal findings)
  • Complex regional pain syndrome or Reflex Sympathetic Dystrophy (RSD)
  • Non-responsive Depression (ketamine infusion)
  • Severe neuropathic pain (lidocaine or ketamine infusion therapy)
• Non- Urgent Referrals
  • The patient must have a family physician or a regular walk-in clinic that will provide follow-up care and medication renewal.
  • Patient is unresponsive to conventional treatment.
  • Patient and/or caregiver are cognitively capable and willing to participate with suggested regimen of therapy.
  • Patient can communicate in English or able to bring an interpreter to all the appointments
  • Patient requires perioperative optimization (SPOC)
  • Referring Physician(s) agrees:
    • to participate with a suggested regimen of therapy
    • to continue to be their primary care provider. changepainTM does not take over primary care of the patient or ongoing medication prescription
    • To order appropriate initial investigations ruling out red flag conditions
    • To send completed results
Medical Services Rejection Criteria
  • Patients without Primary Care Physician or Walk-In clinics able to provide ongoing care.
  • Patient is medically unstable requiring inpatient care and monitoring.
  • Patient has an undertreated ongoing infection source.
  • Patient has untreated/uncontrolled addiction to controlled substances or mental illness, leaving them unable to comply with pain management recommendations.
  • Active WorkSafe BC patients, unless WorkSafe BC has confirmed whether they will cover changepain services.
  • Patients who are 17 years old and under at the time the referral is sent

Meet our interdisciplinary team

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Cost of Initial Assessments - Non-MSP Medical


Private Medical Consultation (PMC) Multidisciplinary Private Assessment (MDPA)
Description Expedited, focused assessment to determine fit for non-MSP covered services requested:
IV Lidocaine Infusion, Ketamine Therapies, Prolotherapy, BOTOX, Platelet Rich Plasma (PRP).
Comprehensive functional and medical assessment with a multidisciplinary report addressing the biopsychosocial issues identified.
Care Team Pain Specialist Pain Specialist
Functional Movement Specialist
Duration 30 minutes 2 hours
Cost $450.00 $3,500.00

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Cost of Initial Assessments - Allied Health


Assessment Duration Cost
Chiropractic Initial 60 minutes $165.00
Physiotherapy Initial 60 minutes $160.00
Kinesiology Initial 45 minutes $90.00 (+ tax)
Counselling Initial 90 minutes $250.00
Acupuncture Initial 45 minutes $140.00
Ketamine Counselling Initial for Ketamine Assisted Psychotherapy 60 minutes $250.00

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