WWW.RAMINSAFAKISH.COM
Home
FAQ
video consult
Narcotic prescription
What kind of pain can be seen in this clinic?
Covered by OHIP?
Phone consult
How to get an appointment?
Who I will talk to?
Who performs the interventions?
Next injection appointment?
Video
Facet joint test
Handouts
English
Farsi Translations
>
Fibromyalgia
Radiofrequency facet neurotomytranslation
Epidural Translation
Lidocaine translation
SI translation
SI and Prolotherapy translation
PRP translation
Lumbar Sympathetic Translation
Stellate ganglion block Translation
Botox translation
Services
consultation
Epidural
Facet Joint injection
Radiofrequency treatment
CERVICAL SPINE RFA
Stellate Ganglion Block
IV Lidocaine infusion
Failed back surgery syndrome (FBSS)
Lumbar sympathetic Block
DGR
Contact Us
Doctor's corner
fun
interesting topics
>
Diabetic Peripheral Neuropathy
Facet generated pain
Failed back surgery syndrome (FBSS)
TranexAmic Acid in non-Cardiac Surgery
increase the duration of nerve block
formula of topical cream for pain
A. Blog
Farsi lecture about End Of Life event
contant office - off line
Your chance of dying
VolunteerNeeded
lidocaine study
*
Indicates required field
DATE (DD-MM-YYYY)
*
Name
*
First
Last
DOB
*
DATE OF BIRTH
AGE
*
Less than 13
13-18
19-25
26-35
36-50
Over 50
Prefer not to say
SEX
*
Male
Female
HEIGHT:
*
CM
WEIGHT:
*
KG
STREET ADDRESS
*
STREET NUMBER AND NAME- CITY NAME
Provinces
*
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
POSTAL CODE
*
Phone Number-HOME
*
Phone Number-WORK
*
OPTIONAL
HEALTH CARD
*
DO NOT USE SPACE AND DO NOT FORGET THE VERSION CODE
WSIB NUMBER
*
ONLY IF APPLICABLE
Is your pain related to an accident?
*
YES
NO
If yes, is your insurance claim still open?
*
YES
NO
DON'T KNOW
FAMILY DR:
*
NAME OF FAMILY DR: PHONE NUMBER: FAX NUMBER:
REFERRING Dr.
*
NAME OF REFERRING Dr. PHONE NUMBER: FAX NUMBER:
1. a) When and how did you current pain problem start?
*
explain about your pain.
b) When the pain first started, how did it start?
*
Gradually
Suddenly
c) Has your pain changed since it began?
*
increased
unchanged
decreased
Please select a number to indicate the maximum of the pain you had during the past 2 weeks:
*
0 - feel no pain
1
2
3
4
5
6
7
8
9
10- maximum pain ever felt in life
Please select a number to indicate the least amount of the pain you had during the past 2 weeks:
*
0 - feeling no pain
1
2
3
4
5
6
7
8
9
10 - maximum pain ever felt in life
Submit
Home
FAQ
video consult
Narcotic prescription
What kind of pain can be seen in this clinic?
Covered by OHIP?
Phone consult
How to get an appointment?
Who I will talk to?
Who performs the interventions?
Next injection appointment?
Video
Facet joint test
Handouts
English
Farsi Translations
>
Fibromyalgia
Radiofrequency facet neurotomytranslation
Epidural Translation
Lidocaine translation
SI translation
SI and Prolotherapy translation
PRP translation
Lumbar Sympathetic Translation
Stellate ganglion block Translation
Botox translation
Services
consultation
Epidural
Facet Joint injection
Radiofrequency treatment
CERVICAL SPINE RFA
Stellate Ganglion Block
IV Lidocaine infusion
Failed back surgery syndrome (FBSS)
Lumbar sympathetic Block
DGR
Contact Us
Doctor's corner
fun
interesting topics
>
Diabetic Peripheral Neuropathy
Facet generated pain
Failed back surgery syndrome (FBSS)
TranexAmic Acid in non-Cardiac Surgery
increase the duration of nerve block
formula of topical cream for pain
A. Blog
Farsi lecture about End Of Life event
contant office - off line
Your chance of dying
VolunteerNeeded
lidocaine study