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Hamilton Health Sciences
Referral Information
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To participate in this program, an individual must attend an assessment at this facility.

Please select the appropriate referral form below, and after completion please fax to 905-577-8022. 

Insurance Referral Form

  • For Motor Vehicle Accident (MVA) referrals:  once we receive the referral, one of our health professionals will contact the patient to complete a screening and gather the information to complete the OCF-18 (application for treatment and assessment).  We will send the OCF-18 to the patient for their review and signature, and then submit to the insurance company for their approval.  Once funding is secured, we will contact the referring agency and/or lawyer for the appropriate medical documentation, and an assessment will be scheduled.  
  • For all other insurance claims, we require written authorization prior to scheduling an assessment. 

Veteran Affairs Referral Form

  • We require authorization number from the Treatment Authorization Centre, which they can email to pain@hhsc.ca or fax to 905-577-8022, or mail to Michael G. DeGroote Pain Clinic, McMaster University Medical Centre, 4th Floor Yellow Section 4V, 1200 Main St. W., Hamilton, ON, L8N 3Z5, Attention:  Sonya Altena.

Department of National Defence Referral Form

WSIB Referral Form

Employer Referral Form

Physician Referral Form

  • If we are not successful obtaining funding for your patient, we will notify your office.

If you have any questions regarding the referral process please contact us:

  • 905-521-7931
  • Toll-free 1-888-243-3653
  • Email:  pain@hhsc.ca

Please note:  to be eligible for our service, treatment costs must be authorized by an insurance company, WSIB, Veteran Affairs, DND, or other funding agency.

 

 

 

 

 

 

 

Hamilton Health Sciences • Hamilton, Ontario • 905.521.2100

Disclaimer: Hamilton Health Sciences (HHS) offers Google Translate to better facilitate access for our community. However, HHS makes no claims regarding the accuracy of translations. Any and all health information should be verified by a health care professional.