referral Forms

Pain Referral

 

Muscle Pain, chronic Pain, Neck Pain, referral form, back pain, wisdom teeth pain, sciatic pain, pancreas pain, pain pills, kidney stone pain, shingles pain, Amara Pain & Spine

We are the most personalized pain management clinic in Charlotte Call – 704 503 9338 Fax 704 503 9339

    For Health care provider

  1. Please provide the information requested in the Amara Pain Spine (APS) Referral form below.

  2. We will schedule appointments at the latest available free spot.

   Please click below to download Referral forms

                       ↓

       APS-Referral-form

 

 ♥      APS New patient intake form

 

 ♥      APS Follow up form

 

For appointments with pain doctor for pain relief call us at – 704 503 9338

6429 Bannington Road, Suite B, Charlotte, NC 28226

Phone – 704 – 503 – 9338

Fax – 704 – 503 – 9339

Email – amarapain@gmail.com

 

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    Pain Patient Instructions

 

  1.  Notify our pain center staff prior to your appointment if you require special assistance (i.e., wheelchair, interpreter, etc.).

  2. Please download our Amara Pain & Spine- APS New patient intake form above and start filling out pertinent information.

  3.  Bring your Amara Pain & Spine – APS New patient intake form and arrive 30 minutes prior to your appointment to allow time for registration.

  4.  Please bring your insurance card, copay amount, current list of pain medications and dosages, previous medical records including Labs, CT, MRI, Xray, Physical therapy or chiropractic records, recent doctors or healthcare provider notes, previous surgery reports, medication bottles.

 See what Back pain patients say after referral 

 

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