Low Back

Referral Form / Central Intake

Patient Visit

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Patient Visit

Who Should Be Referred?

  • Patients with Low back pain and /or low back-related leg symptoms of at least 6 weeks duration, but no longer than 1 year

  • Patients with unmanageable or recurrent low back pain

  • Patients must be 18 years or older

Who does not qualify?

  • Pain that is a result of an accident (Motor vehicle /workplace covered under WSIB)

  • Conditions that require urgent or emergency care – patients should seek emergency care if required

  • Long-standing low back conditions (greater than 12 months in a row with no relief), as the program is not designed for chronic conditions

  • Patients under the age of 18

  • Pregnant or within 12 months after childbirth (<1 year) 

 What imaging should be completed prior to submitting the referral? 
  • None needed – the goal of the program is to decrease the utilization of imaging

Who will I see?

  • You will be initially assessed by an Advanced Practice Provider (APP), a specially trained physiotherapist or chiropractor, who has undergone additional training with our Spine Surgeons.
  • They have advanced skills and training to provide you with a program that includes a detailed standard assessment and education about your condition.
  • They will work together with both surgeons and your PCP to ensure you get the most appropriate care.
  • The APP will determine the best course of management and if required, recommend diagnostic imaging or consultation with a surgeon.
  • Patients who require a surgical consultation can choose the “first available” surgeon and will experience shorter wait times or can choose a surgeon or hospital of their choice. 
  • If applicable, appointments with the Spines Surgeon will vary based on each surgeon.

What will my appointment with the APP consist of?

  • To optimize your time with the APP, we recommend that you download and complete the patient intake form prior to your first appointment.
  • Review your medical history, surgical history, medication, and functional limitations
  • Comprehensive physical examination
  • Personalized treatment plan
    • **If more investigations are needed, you will be referred to the Practice Lead for surgical triage
  • If required, recommend diagnostic imaging or consultation with a surgeon
  • Potential follow-up visits (from 1-4)

Will the APP provide treatment?

  • The APP for the RAC – LBP does not provide treatment (hands-on therapy).  It is an inter-professional shared care model that provides evidence informed assessment, education and personalized self-management plan.
  • Self-management plans include advice on staying active, as well as instruction on exercises and modified activities as needed.
  • Patients can also be connected to services in their local community if they need more supervised care.

How long will I wait for an assessment? 

  • Ministry of Health has mandated that patients be assessed by an APP within 4 weeks of receiving the referral 

How long is my appointment?

  • Initial appointments are approximately 60 minutes
  • Follow-up appointments are approximately 30 minutes  

What should I bring?

  • Health Card
  • List of medication, including over-the-counter medication , and an allergy list


  • If you are unable to keep your appointment or need to change it for any reason; please notify the clinic within 2 business days of your scheduled appointment.  

Virtual Visits

Virtual visits are available for those that live in remote areas or where travel is difficult.  Appointments can be done with the APP via videoconferencing with use of computer, tablet or smartphone. Please let your APP know which option you prefer (face- to- face vs virtual) when they call you to book an appointment.