top of page

Referral Form

Doctor's Desk

Download the fillable Referral Form and fax it to the clinic to begin the referral process.

​

Referral Forms (Fillable PDF): 

​

 

 

​

 

​

​

​

​

Clinic Fax Number: (905) 225-0130

​

Thank you for your referral to our headache neurology clinic. Due to the high demand for specialized headache care and extended wait times, we have established specific guidelines to ensure that we can prioritize treatment-resistant cases and provide timely care to patients who need it the most.

 

Requirement for Oral Preventive Therapies:

We kindly request that patients referred to our clinic have trialed at least two different oral preventive therapies prior to their referral. This approach serves several important purposes:

 

  1. Optimization of Treatment: Many headache patients can achieve significant improvement with first-line oral preventive therapies. Ensuring that these options have been adequately trialed can prevent unnecessary delays in effective treatment.

  2. Resource Allocation: By focusing our clinic on patients who have not responded to initial therapies, we can better allocate our resources and reduce wait times for those with more complex and treatment-resistant headache disorders.

 

Documentation of Trials:

When referring a patient to our clinic, please include documentation of the following:

  • Names and dosages of the oral preventive medications tried.

  • Duration of each medication trial (typically, at 3 months is recommended for an adequate assessment).

  • Patient response to each medication, including any side effects experienced.

  • Other relevant medical history and current medications.

 

We appreciate your understanding and cooperation in helping us provide the best possible care for our patients. Should you have any questions or need further clarification, please do not hesitate to contact our office.

​

​

General Neurology Referral Form (CURRENTLY NOT ACCEPTING)

300G Fourth Ave. Unit 202 (Second Floor)

St. Catharines, ON L2S 0E6

Copyright © 2025 Niagara Centre for Headache and General Neurology. All rights reserved. 

bottom of page