Partner with Us

Refer Your Patients for Expert Pain Management

We value collaboration with fellow healthcare providers to ensure patients receive the specialized pain management care they need. Our team is dedicated to providing prompt, professional, and compassionate treatment to support your patients’ health and well-being. Referring to our clinic is simple and efficient—just fill out the form below to get started.

Benefits of Referring to Our Clinic

  • Comprehensive pain management care tailored to each patient.
  • Timely updates on your patient’s progress and treatment plan.
  • Access to advanced, evidence-based treatments and procedures.
  • Collaborative approach to ensure continuity of care.

Referral Form:

    Referring Physician’s Information

    Patient Information

    Reason for Referral


    Additional Notes

    I confirm that the patient has provided consent for their information to be shared.

    To ensure comprehensive care, please fax any relevant patient documentation, including medical history, imaging, or treatment notes.

    Terre Haute, IN Fax Number: 812.232.1489

    Bloomington, IN Fax Number: 812.339.5413