Functional Independence Restoration
Contact / Refer

Appointments

Schedule your appointment with the FIRST Program by phone.

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Admission Criteria

Our program is not appropriate for all patients with chronic pain. Before submitting a referral, please make sure your patient meets the following criteria:

Patient is 10 to 17 years old and has a primary chronic pain condition and severe functional disability
Patient has completed a diagnostic work-up and is cleared for participation in physical activities for all medical conditions
Patient has participated in outpatient pain-focused behavioral/psychological therapy
Patient has participated in outpatient physical/occupational therapy
Patient and family are motivated and willing to engage in a functional approach (they are not seeking additional procedure or medical solution to pain)

Physician Referrals

We require a referral from a healthcare provider prior to scheduling an appointment. Providers should make a referral by faxing a Specialty Services Form—available at the link below—along with the following. Please select “Chronic Pain Management-FIRST program” when completing the form.

Insurance information including phone number (clear copy of front and back of card)
Medical records from all relevant providers whom the child has seen, past and present
MRIs or X-rays disc, labs and reports, if applicable
A letter of medical necessity

Once all information has been received and reviewed, we will contact the family to schedule the initial evaluation. There are instances when insurance carriers may require a prior authorization before patients can be seen.

Refer a Patient