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Referral Form

We work with health professionals in all ﬁelds to help achieve the best results for scoliosis patients.

› Referrers Form for Professionals

Health Professional Referral Form

ScoliCare welcomes referrals from other health professionals to co-manage patients with scoliosis, kyphosis, and related spinal conditions.

Location

Select the preferred ScoliCare Clinic

Referring Health Professional Details

Title

Referrer First Name:

Referrer Last Name:

Profession

Other

Email

Phone

Practice/Clinic Name

Practice/Clinic Address

City

Country

State

State

Postcode/Zip

How did you hear about ScoliCare?

Other

I am a ScoliBalance ProviderScoliBalance is ScoliCare's physiotherapeutic scoliosis exercise program (PSSE). If you are interested in training as a ScoliBalance Provider, click here.

Patient Details

Patient First Name:

Patient Last Name:

Email

Phone

Birthdate

Patient Address

City

Country

State

State

Postcode/Zip

Referral for:

Scoliosis	Kyphosis
Exercise program	Brace assessment
Shoe Lift	Scoliosis Ultrasound (Sydney South / Melbourne only)

Details:

The patient/parent/carer has given permission for ScoliCare to contact them about making an appointment

Yes	No (Please ask patient to call 1300 883 884)

Health Summary

What symptoms is the patient experiencing?

Please list any past diagnoses and relevant medical history:

Attach File 1 (e.g. AP/PA x-ray)

Attach File 2 (e.g. Lateral x-ray)

Please send me email updates on scoliosis related information, including education, research, products and events

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ScoliCare recommends seeking advice from a qualified and specifically trained scoliosis clinician. To find a scoliosis clinic near you, click here

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Dr. Jeb McAviney

CEO, Chiropractor

Dr. McAviney is the CEO of ScoliCare and one of the world’s leading authorities on non-surgical scoliosis treatment.

With a Masters degree in Pain Medicine as well as a Masters degree in Chiropractic, Dr. McAviney brings a wealth of experience in scoliosis treatment, education, and research.

Dr. McAviney oversees all cases and gives guidance to the clinical team. He drives research development initiatives to ensure patients get access to the latest and most evidence based procedures. He is also a Board Member of SOSORT (The International Society on Scoliosis Orthopaedic and Rehabilitation Treatment).

Scoliosis Accreditations:

World Masters Course in Scoliosis Management
Scientific Exercise Approach to Scoliosis (SEAS) Therapist – Level 3, Advanced, Basic
SCHROTH trained
SpineCor Scoliosis Bracing Clinician & Instructor
SpineCor Scoliosis Physiotherapy Instructor
Chiropractic Biophysics Instructor
Neuromechanical Instrument Adjusting Instructor
Advanced Fellow of Chiropractic Biophysics
ScoliBalance Course Creator, Developer and Trainer

Dr. Jeb McAviney

CEO, Chiropractor

Dr. McAviney is the CEO of ScoliCare and one of the world’s leading authorities on non-surgical scoliosis treatment.

With a Masters degree in Pain Medicine as well as a Masters degree in Chiropractic, Dr. McAviney brings a wealth of experience in scoliosis treatment, education, and research.

Dr. McAviney oversees all cases and gives guidance to the clinical team. He drives research development initiatives to ensure patients get access to the latest and most evidence based procedures. He is also a Board Member of SOSORT (The International Society on Scoliosis Orthopaedic and Rehabilitation Treatment).

Scoliosis Accreditations:

World Masters Course in Scoliosis Management
Scientific Exercise Approach to Scoliosis (SEAS) Therapist – Level 3, Advanced, Basic
SCHROTH trained
SpineCor Scoliosis Bracing Clinician & Instructor
SpineCor Scoliosis Physiotherapy Instructor
Chiropractic Biophysics Instructor
Neuromechanical Instrument Adjusting Instructor
Advanced Fellow of Chiropractic Biophysics
ScoliBalance Course Creator, Developer and Trainer

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About Scoliosis
About Kyphosis
- What is Hyperkyphosis?
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In the USA and Canada, health professionals who do not meet the minimum qualifications to become a Certified ScoliBalance Provider may become a ScoliBalance Assistant allowing them to carry out ScoliBalance rehabilitation activities working under direct supervision of a Certified ScoliBalance Provider.

The below guidelines are applicable for a ScoliBalance Assistant:

ScoliBalance Assistant must work under the direct supervision of a Certified ScoliBalance Provider at all times
ScoliBalance Assistants receive a certificate of completion
ScoliBalance Assistants may attend the training webinars through the Supervisor’s account
ScoliBalance Assistants do not need to pay the annual ScoliBalance subscription fee
ScoliBalance Assistants do not have access to ScoliCare Central
ScoliBalance Assistants are not listed on the ScoliCare website as a ScoliBalance Provider
ScoliBalance Assistants must accept ScoliCare’s training programs terms and conditions

Minimum level qualifications required to become a ScoliBalance Assistant include Physical Therapy Assistant Certification, Personal Trainer Certification, or Chiropractic Assistant Certification. If you have questions about whether you have the appropriate qualifications for becoming a ScoliBalance Assistant, please contact us at support@scolicare.com

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