Referral Form / Central Intake

Patient Visit

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Patient Visit

Who Should Be Referred?

  • Rotator Cuff Tears (Full- thickness or high-grade partial-thickness)
  • Inflammatory or Degenerative Arthritis of the Glenohumeral Joint
  • Unmanageable Impingement / Tendinitis / Frozen Shoulder

What imaging should be completed prior to submitting the referral?

  • X-Ray (AP, lateral, axillary & outlet)
  • Ultrasound or MRI

Who will I see?

  • You will be initially assessed by an Advanced Practice Provider (APP). If you are deemed a surgical candidate, an appointment with an orthopedic surgeon will then be arranged.

How long will I wait for an assessment?

  • Each referral is reviewed and triaged according to severity.Some may be seen more urgently based on the findings of the imaging provided.
  • Appointments with orthopedic surgeons will vary based on each surgeon’s wait times

What will my appointment consist of?

  • Review your medical history, surgical history, medication, and functional limitations
  • Review your x-rays / MRI/ Ultrasound (further imaging may be ordered)
  • Physical examination
  • Personalized treatment plan

How long is my appointment?

  • Initial appointments are 40 minutes
  • Follow up appointments are 20 minutes
  • *If new x-rays are needed you will need to present to your appointment prior to the scheduled time. Please check with each individual NEJAC for their protocols

What should I bring?

  • Health Card
  • List of medications, including over the counter medications, vitamins, and allergies
  • A tank top that will expose your shoulder and arm
  • You can bring a family member or caregiver with you
  • Reading glasses so that you can fill out your forms


  • 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.