Make a Referral

PROVIDER REFERRAL IS REQUIRED TO MAKE AN APPOINTMENT AT THE SHEPHERD SPINE AND PAIN INSTITUTE

Referring Providers

Please download the Shepherd Spine and Pain Institute Provider Referral Form. Email or fax the completed forms and pertinent 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 the New Patient Coordinator at (404) 603-4203 or painreferrals@shepherd.org with any questions or concerns.