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.