Referrals Made Simple


Referrals Made Simple

Referrals made simple with our easy 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 (866) 702-0880

You are also welcome to call our phone number at  (205) 332-3160 and refer through our call center verbally if you’d like.

Thank you!

Referrals Made Simple