Referrals

Our simple to use Referral Forms are built to take hassle out of continuing on your patient’s Pain Management needs.

Step 1: Click the Image on the right to download the form.

Step 2: Fill out the form digitally on the computer or printed with pen.

Step 3: Save the form to your patient’s records for your own copy.

Step 4: Fax the form to (877) 795-8060

You are also welcome to call our phone number at (405) 601-8810 and refer through our call center verbally if you’d like.

Thank you!