IMPORTANT:

1) If your name or Personal Health Number is listed incorrectly, we will be unable to process the referral. 

2) If you do not have MSP coverage, please email us PRIOR to filling out this questionnaire. 

3) All appointment notifications are sent to the referring doctor's office. As all confirmations are done ONLINE, if you do not have access to email for communication, please arrange for this to be set up, or to have a friend/family member assist you with this. 

Fraser Spine

© 2018 Dr. Michael Nikolakis Inc.