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Referral Form Instructions - Wasser Pain Management Centre


Your physician has referred you to the Wasser Pain Management Centre.  The Wasser Pain Management Centre is an out patient adult treatment, education and research facility. We are located in Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario.

Your referring physician will provide you with an intake package to complete and return to our Centre.  Please provide a photocopy of your completed package to your referring physician for their records.

This package provides us with valuable information about your pain condition and must be returned to us before we can schedule your first any appointment. 


It is a requirement of our Centre that all patients are under the care of a family physician who is willing to participate in your ongoing pain management.  Please complete all of the attached documentation and return with your completed package.                                                


  1. After we receive all of the required documentation, your file will be reviewed and your referring physician will be notified of your appointment date and time.  Please note that it may take up to 12 months after receipt of all documentation to receive an appointment. 
  2. Your initial appointment will be for assessment only and will be 1 to 1½ hours in length.
  3. We will provide assessment and recommendations only for those patients who live outside of the Greater Toronto area.
  4. It is necessary for you to bring your health card and Mount Sinai card (obtained in the admitting department on the main floor) to all of your appointments.
  5. Bring all prescribed medication in the original bottle to your appointments.

If you have any questions about your referral please contact your referring physician or visit our website at