ULTRASOUND-GUIDED INJECTION REFERRAL

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Dr. Sherif El-Maadawy MB B Ch, MSc, FRCP(C), Master-CIME, Physiatrist
Dr. Brian Loewen MD, CCFP, Dip. Sport Med.

Patient Information

Address
Gender

Dr. I. El-Gouhary MB B Ch, LMCC, CCFP, CIME
Dr. O. Vicaruddin MD, PgCPain, CIME

Physician Information

Physician Address
Active WCB

CLINICAL HISTORY

PROCEDURE REQUESTED

Therapy Choices
Shoulder
Elbow
Wrist & Hand
Hip & Pelvis
Knee
Ankle & Foot

If possible, please provide a list of current medications and relevant medical information.
*These products are available at our clinic at additional costs.