Physicians Making a Referral to Pain Care Specialists of Oregon

To make a referral, please complete the following forms:

  • Pain Care Specialists of Oregon Referral Ticket Download
  • Patient recent chart notes which may include the history of medical history, medication use, Physical Therapy, imaging report if applicable.
  • Patient demographic including patient’s name, DOB, contact number, address, and information of primary insurance, secondary insurance, and tertiary insurance if applicable.
  • Insurance Authorization Approval letter for referral if available.

For your convenience, you may submit referrals by faxing completed forms to (503) 371-0805

Once received, your patient will be called within 24 hours to set up the initial evaluation at their earliest convenience. Additional time may be needed if prior authorization is required. If the case is of an urgent nature and an immediate appointment is needed, please call our office so we may assist you more quickly.

Please contact us if you have any questions or concerns via Text or call at (503) 371-1010 or email at