If your insurance does not require any referral to specialists, we at Pain Care Specialists of Oregon are happy to treat self-referring patients with the following restrictions:

To make a referral, please complete the form below and provide us the documents from the list below:

  • 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.

If the management of narcotics is required, each patient must have a primary care physician. Pain Care Specialists of Oregon is not able to manage a patient’s narcotics without the involvement of a primary care physician.

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

Our New Patient Coordinator will contact you within 24 hours to set up the initial evaluation at your earliest convenience. 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 contact@paincareoregon.com.