PROVIDER REFERRAL FORM

Since 1995, The Physicians Spine and Rehabilitation Specialists has provided innovative, effective and comprehensive treatment of pain with special emphasis on spinal pain and care of the injured worker. We strive to improve our patients’ quality of life and restore function to individuals suffering from acute and chronic pain conditions. We offer a variety of non-surgical treatment options for spinal pain using the most advanced diagnostic and therapeutic techniques to identify and eliminate or minimize pain at its source. Our physicians have all earned subspecialty board certification in Pain Management; the only pain management certification recognized by the American Board of Medical Specialties. We are committed to providing our patients with compassionate and comprehensive pain care of the highest quality. We welcome the opportunity to work with you and to help your patients better understand their condition and the treatment options available to them.

By my signature, I acknowledge that I have read, understand, and agree to the policies and procedures of the Physicians Spine and Rehabilitation Specialists of Georgia, PC, as defined in the New Patient Packet that I received. I HEREBY CERTIFY that the information provided in this form is complete, true and correct to the best of my knowledge.