If your current health insurance plan requires your primary care physician or specialist to complete a Patient Referral Form for your appointment at PainMD, you can:
Once you have scheduled an appointment at one of our PainMD clinics, at least two weeks prior to your appointment time, please print and complete the downloadable form below, and take it to your primary and/or referring physician’s office.
Please check with your physician’s office, you may be required to sign additional forms to have your records released to us. Please have your records sent to the same PainMD clinic location where you have an upcoming appointment directly from your physician’s office. We cannot accept hand-carried records provided by patients or family members.
It is very important that we receive all of your records. If your records are incomplete at the time of your initial appointment, you will be seen, but you may not be provided with medications until your records are complete.
Do NOT bring copies of your medical records, including notes from other physicians, laboratory reports, or other personal health information. These records will only be accepted DIRECTLY from your physician(s). Radiology reports and DVDs may be accepted at your PainMD provider’s discretion.
We accept Medicare, Workers’ Compensation and most major insurances. Please contact the clinic nearest you for specific details related to your insurance coverage.