Referring Providers

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Referring Your Patient

To refer your patients to Willamette Pain & Spine Center, complete our Referral Request Form and fax it to us at (503) 512-1220. Our staff will contact your patient and schedule an office visit.

All scheduled appointments require a physician referral. Referral and authorization from the patients’ health plan may also be required. Patients should check with their insurance carrier to ensure coverage. Please assist us by providing the following information when submitting the Referral Request Form:

  • Referral Request Form (new)
  • Copy of Insurance Card
  • Motor Vehicle Billing Information
  • Recent Chart Notes
  • Recent Diagnostic Imaging
  • Recent Physical Therapy Notes
  • Letter to Specialists: This form may be delivered to your primary care provider regarding the prescription of medications.