Advanced Pain Medicine accepts patients by physician referral only, we do not accept self-referrals.  All referred patients require “Record Review” by our physicians to determine medical appropriateness for treatment in our clinic.

To refer your patient the following information is necessary to expedite record review, insurance authorization (if required) and scheduling of those patients accepted to our clinic.

Please Use The Following Checklist for Patient Referrals:

  • Completed Referral Form
  • Send Last 6 Months of office notes
  • Insurance Cards Front/Back

For Work Comp Referrals please use the below checklist in addition to the above list.

  • Work Related Diagnosis
  • Date of Injury
  • Employer at the time of accident
  • Claim Number
  • Work Comp Carrier, Billing Address and Phone Number
  • Contact person name and number
  • Patient Attorney Name and Number
  • Copy of Court Order

Fax all information to:  316-942-4655 Attention: NEW PATIENT COORDINATOR

Any questions for coordinators please call 316-942-4519

**Not receiving intake information in full could delay getting your patient scheduled in a timely fashion.

Thank you for the referral and we appreciate your business. -APMA