Add you clinic to our Headache Clinic Locator Database. Home » Find a Specialist » Headache Clinics in Canada Questionnaire Thank you for your interest in having your clinic added to our Headache Clinic list. Please complete the intake form below. By submitting your clinic information, you consent to having it posted on our clinic locator. Name* First Last Please enter your name or the point of contact.Contact Email*Your contact email is for internal communication only and will not be posted online. Your email will be added to our Migraine Minute monthly bulletin that includes information on new resources and programs Migraine Canada has available. We hope you will share our resources with your patients. Provide the names of health care providers involved in headache care at your clinic.What is the name of the clinic?*Clinic Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Clinic Phone number*ExtensionClinic Emailif available Clinic WebsiteClinic Fax numberChoose what describes the Clinic best. Outpatient clinic, public Outpatient clinic, private (out of pocket payments) Academic, part of a University Department Hospital-based (non-university) How many physicians are part of the Headache Clinic? 1 (solo practice) 2-3 4 + Which of the following work in your clinic?Check all that apply Registered nurse Nurse practitioner Neurologist Physiatrist Internist Family physician Neurosurgeon Ophthalmologist ENT specialist Dentist Temporomandibular disorder specialist Other Please specifyDo you see?check all that apply Adults Teens (12-18) Children (<12) Do you accept referrals for the following?Check all that apply. Migraine Cluster headache Facial pain / trigeminal neuralgia Acute / new onset headaches <1 month Post-traumatic headache, acute (concussion, mTBI) Post-traumatic headache, chronic Patients on long acting opioids for another pain What medical services do you offer?Check all boxes that apply. Medical evaluation and follow-up Emergency visits (<7 days access if needed) Monoclonal antibodies Medical cannabis Opioid management Which procedures do you offer?Check all boxes that apply Botox injections Injections/nerve blocks, no radiology guidance Injections/nerve blocks, with radiology guidance Injections/nerve blocks with ultrasound guidance IV medications / infusions SPG blocks Neurostimulation (implanted) What behavioral services do you offer?Please select only if the allied health care providers are working with you and you have a regular interaction with them, not if you refer to other independent clinics. Allied health care providers can be paid independently by patients. Check all that apply. Physical Therapy/Physiotherapy Biofeedback CBT, sleep CBT, Acceptance Commitment Therapy CBT, other Mindfulness Program Lifestyle management coach Nutritionist Occupational therapy Support groups Education Sessions Other Please specify (Other)*Do you provide medical expertise for insurance, disability etc? Yes No Do you accept?Check all that apply. Patients who are self-referred Referrals from physicians (GP and specialists) Referrals through the hospital system only Referrals from any health care provider I don't take new patients What is your usual waiting list for a usual headache referral?Select best answer for usual referral, not for expedited access. <1 month 1-3 months 3-6 months 6-12 months >1 year Do you engage in research?Check all that apply. Research led by industry Original research from our team No active research at present time Comments:
