Saskatchewan Spine Pathway Clinic FAX to Regina 306-766-7551 - sasksurgery-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient information in the designated fields, including Name, HSN, Address, and Phone numbers. Ensure accuracy for effective communication.
3. In the 'Back Specific History' section, check the appropriate boxes for pain location and answer questions regarding pain characteristics and previous treatments.
4. Provide detailed responses for aggravating and relieving factors of pain. This information is crucial for assessment.
5. Complete the 'Back Specific Physical Exam' section by indicating results from movement tests and reflex assessments. Use checkboxes for clarity.
6. Fill in the 'Diagnosis and Treatment' section with patterns observed and any co-morbidities. Include comments as necessary.
7. Finally, ensure that the referring practitioner's name, discipline, address, signature, and date are filled out before submitting via fax to Regina.

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