PROVIDER REFERRAL IS REQUIRED TO MAKE AN APPOINTMENT AT THE SHEPHERD SPINE AND PAIN INSTITUTE
Please download the Shepherd Spine and Pain Institute Provider Referral Form. Email or fax the completed forms and pertinant medical records to (404) 603-4418.
Requested Medical Records:
- Demographic sheet
- Consultation note and office visit notes
- Diagnosis reports (X-rays, CTs, MRIs, EMGs, etc.)
- Procedure Notes
- Operative Notes
Please contact New Patient Coordinator at (404) 603-4203 or firstname.lastname@example.org with any questions or concerns.