Skip to main content

Referral Forms (for healthcare providers)


 

If you would like to refer a patient to our practice...

1. Please print and fill out the referral form below

2. Fax it to our office at (847) 593-6803

3. We will contact the patient and schedule their initial consultation.

(If available, please fax recent physician notes as well as reports of any diagnostic reports including: MRI, CT, X-rays, EMG, U/S, labs, etc.)

Referral Form (for healthcare providers)

Referral Forms

 

Get pain relief now – call today to learn how Innovative Pain Specialists can help!

Our Locations

Choose your preferred location