Shoulder Referral

If you are referring your patient to our clinic for shoulder pain or instability, please fill out the following form in its entirety and fax it to (780) 457-4393.

Please attach any completed imaging and any relevant medical history to the referral. Imaging is not required for referral acceptance. However, if you are sending your patient for imaging, please see our page on Diagnostic Imaging and Referrals. If you have questions regarding your referral, please contact our referral coordinator at (780) 377-1410.

If you feel that your patient’s shoulder concern is urgent or emergent, please call the Orthopedic Consult Line at 1-800-282-9911.

Please note: We do not accept WCB patients. If your patient has a WCB claim regarding shoulder pain or instability, they need to be referred by their case manager to the visiting specialist clinic at WCB.