Physician Referrals

Text For An Appointment
Call (602) 773-7671

Please fill out the form below.

Fax the following items to (480) 636-8890

  • History, physical and progress notes.
  • Recent imaging, if applicable.

    Patient's Name (required)

    Which Regional Pain Doctor's Location Will See The Patient?
    QueenCreek/San Tan ValleyApache Junction

    Treatment Options

    Botox InjectionsCeliac Plexus/Splanchnic Nerve BlockCortisone InjectionsEpidural Steroid InjectionsFacet Joint InjectionsGanglion Impar/Coccygeal Nerve BlockJoint and Bursa InjectionsKyphoplastyMedial Branch BlocksMedication ManagementMuscle RelaxersOccipital Nerve BlockPeripheral Nerve Block

    Radiofrequency AblationSacroiliac Joint InjectionsSI Joint InjectionsSphenopalatine Ganglion BlockSpinal Cord StimulationStellate Ganglion BlockSuperior Hypogastric Plexus BlockTrigger Point InjectionsPlatelet Rich Plasma (PRP) TherapyUltrasound Guided ProceduresVertebroplastyViscous Supplementation