Referral Information

If you are a provider and are wanting to refer a patient to our office, please fax the applicable information as indicated below.

Pain Referrals:

• Referral signed by referring provider

• Patient demographics

• Insurance information
  *please include both front and back of the patient’s insurance card(s) *

• Reason for the referral and contact information of referring provider
  (Name of referring provider, NPI, Address, Phone, and Fax)

• Office notes (last three)

• Labs, XRays, MRIs, CTs

• Warning letters or letters of dismissal

Please fax the above information to:
Fax #: 405.285.7546
Attn: New Patient Coordinator
**Our office will contact you when your patient has been scheduled

Sleep Referrals:

• Referral signed by referring provider

• Patient demographics

• Insurance information
  *please include both front and back of the patient’s insurance card(s) *

• Reason for the referral and contact information of referring provider
  (Name of referring provider, NPI, Address, Phone, and Fax)

• Office notes (last three)

• Previous sleep study, if any

Please fax the above information to:
Fax #: 405.285.7546
Attn: New Patient Coordinator
**Our office will contact you when your patient has been scheduled

Workers’ Compensation Referrals:

• Referral signed by referring provider

• Patient demographics

• Workers’ Compensation (WC) information

• Name of WC Carrier

• Claim Id #

• Social Security #

• Date of Injury

• Employer

• WC diagnosis codes

• Adjuster Name, address, phone #, and fax #

• Reason for the referral and contact information of referring provider
  (Name of referring provider, NPI, Address, Phone, and Fax)

• Office notes (last three)

• Labs, XRays, MRIs, CTs

• Warning letters or letters of dismissal

Please fax the above information to:
Fax #: 405.285.7546
Attn: New Patient Coordinator
**Our office will contact you when your patient has been scheduled

We are currently not accepting MVA patients.