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For Physicians
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It is our pleasure to work with
you in addressing the pain management needs of your patients in pain.
We offer a vast variety of services including appropriate medication
management, cutting edge interventional techniques and comprehensive
plans of physical and psychological rehabilitation. Please do not
hesitate to call us with any questions regarding your patients
currently being treated at Comprehensive Pain Management Center or
otherwise. We look forward to our continued working relationship.
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| Referral form
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Please send the following
information to FAX #: 408-356-5307:
• Face sheet with patient's
demographic information
• Insurance information: Work Comp/Private Insurance/Medicare (copy of
both sides of card)
• Insurance Authorization if needed (for HMO's and Worker's Comp)
• Last three months worth of Medical Records pertaining to the reason
they are being referred
• MRI Report / EMG Report / X-Ray Report / CT Scan Report, etc.
Once we receive all the
information listed above, our office will contact your patient within
48 hours to set up their initial consultation.
Sincerely,
Annu Navani, MD
and the team at CPainMC.
Thank you for your
referral!
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