The Hodgson Orthopedic Group believes that superior patient outcomes are achieved when allied health professionals can collaborate. If you believe that one of your patients would benefit from our orthotic or prosthetic treatment, please feel free to fill out the following document. We use this information to align professional goals and have our process facilitate parallel treatment pathways.

Please complete the intake form online
OR download and fax in your completed form.
Online Intake Forms
Inpatient spinal brace requisition form

  • Date Format: YYYY slash MM slash DD

  • Date Format: YYYY slash MM slash DD

  • Accepted file types: jpg, gif, png, pdf.

Limb Orthosis intake form

This form has been created to coordinate goal setting between allied health practitioners to maximize treatment outcomes. Please highlight your specific areas of concern and the goals you would like to see your patient achieve.

  • This field is for validation purposes and should be left unchanged.

Hodgson Orthopedic Group
113-250 Schoolhouse St
Coquitlam, BC V3K 6V7
Phone: 604 520-7332
Fax: 604 521-7300

Hodgson Orthopedic Group
118-12414 82 Ave
Surrey, BC V3W 3E9
Phone: 604 597-4784
Fax: 604 597-3902