Refer A Patient

Refer a Patient

If you have a patient struggling with chronic pain and you’d like to discuss the case, please call our PROVIDER HOTLINE at 844-562-0518.

If you have a patient struggling with chronic pain and you’d like to discuss the case, please call our PROVIDER HOTLINE at 844-562-0518.

Thank you for choosing CPI. Our team is committed to providing exceptional care for your patient’s pain management needs. Please select one of our referral forms below to get started.

Refer a Patient – Pain Evaluation

Patient Name(Required)
MM slash DD slash YYYY

Referring Provider Information

Provider name(Required)

Plan of Care

Purpose for appointment
Follow up reports should be delivered:
Communicate plan of care via:

Refer a Patient – Procedure-Only

Patient Name(Required)
MM slash DD slash YYYY

Referring Provider Information

Provider name(Required)

Plan of Care

Purpose for appointment
Follow up reports should be delivered:
Communicate plan of care via:
E.g. physical therapy, medication management, etc.