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Physician Referrals



Our goal is to work with the referring provider to give our mutual patient the best care possible.  Pain Management Group (PMG) will provide complete evaluation and treatment plan for the patient.  We will see your patient in a timely manner and provide you with our report as we know communication between PMG and the referring providers is important. 

Referral Information:

You or your office staff may call our main office at 574-251-0498 or toll free 877-614-PAIN [7246] or complete and fax the physician referral form (see below).

Please provide us with the following information:

Patient's name and date of birth

Patient's demographic information (including phone numbers, address and insurance information)

Pertinent medical records including any MRI, CT scan or x-ray reports

Reason for referral and referring diagnosis

Downloads:

Physician Referral Form

Forms require Free Adobe Reader Software - download here, if needed.