PRINTABLE DOCUMENTS

Please find printable versions of intake forms, pain diaries and information sheets on this page. If you have any questions please contact our office.

FORMS

DIARIES

PRP

INFO SHEETS

If you are interested in Platelet Rich Plasma(PRP) and would like to receive an assessment for your tendon/joint/ligament pain, please fill out the intake form below and have your doctor send a referral to our clinic. Please make sure you have also had some type of imaging(MRI, X-ray, Ultrasound etc) within the last 2 years.

*Please note this form is only to be filled out if you are interested in treating non-spine issues such as joints, tendons, or ligaments. If you are interested in having your back or neck assessed you will need to complete the New Back/Neck Consultation Questionnaire

*We are only treating patients who reside in Canada. Before taking the time to fill out the questionnaire below, please know that the regenerative procedures performed at the clinic are not covered by provincial health care plans and will need to be paid for by the patient.

 

Central Alberta Pain & Rehabilitation Institute, CAPRI

#1, 6220 HWY 2A, Lacombe, AB, T2L 2G5

 © 2020