Pain Management
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New Patients

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” when completing the form.

  • Medical records including PCP office notes and Specialist office notes 
  • MRIs or X-rays disc, labs and reports
  • Insurance information including phone number (clear copy of front and back of card)
  • Demographics

While this may seem to some like an extra, unnecessary step, having a complete medical history is important because our providers want your child’s appointment to be as productive as possible and they don’t want to repeat tests that have already been done if not necessary.

All new referrals are carefully reviewed by a nurse practitioner for appropriateness clinically and completeness of medical history. We kindly ask for your patience during this process which may take up to 24- 48 hours. After this is completed, a member of our staff will contact the family directly to schedule an initial evaluation.

It is the responsibility of the family to contact their insurance carrier for visit coverage and to make sure providers are in-network. In some instances, our office may contact the insurance carrier for prior authorization.

For out-of-state Medicaid patients, the referring physician must start the prior-authorization process by providing the insurance carrier a letter of medical necessity including clinical notes. At times, a peer to peer phone conversation is needed between the referring physician and the insurance clinical director for approval of out-of-network services.

Refer a Patient

For More Information

For more information, speak to a team member by calling 513-636-7768.