We Welcome Patient Referrals!
The Center for Pain Management accepts patient referrals from treating physicians, insurance companies, employers and health plan case managers.

Physician Referrals for Patients Who Need Comprehensive Pain Management

Center for Pain Management welcomes physician referrals for patients suffering from acute and chronic pain conditions. We take a partnership approach in working with treating physicians to ensure continuity of care, full disclosure of medical history and co-development of health plans that offer the best opportunity for successful outcomes.

If you have a patient you’d like to refer to our practice, please use the “Refer a Patient” form to schedule a consultation with a clinical member of our patient referral team.

We Accept Physician Referrals for Patients with Chronic and Acute Pain

Please fill out and fax the appropriate patient referral documentation to our office at 317.706.3417:

Adobe-PDF-icon  New Patient Referral Form


Adobe-PDF-icon  Physical Therapy Patient Referral Form


Adobe-PDF-icon  MRI Procedure Referral Form


Center for Pain Management also offers treating physicians medical case consultations and medical second opinions.

NOTE: Our office must receive the patient’s medical records from a current physician PRIOR to the patient’s appointment.

Refer a Patient
This form is for health care professionals to refer patients. Medical records from current physician must be received prior to appointment.
  • Referring Office Contact Info

  • Patient or Case Information

  • This field is for validation purposes and should be left unchanged.