Pain Management Referrals
To refer a patient to our Pain Management Program, complete our online patient referral form below or print a physical form (PDF format) and fax it to us at 612-444-9000. Please include the following information:
- Reason for referral/primary diagnosis
- Conditions to evaluate and treat
- 3-6 months of past medical records, including visit notes
- Any relevant pathology or imaging results
You can also call our office at 612-444-3000 or fax your own referral form along with clinic notes.
Addiction MAT Referrals
To refer a patient to our Addiction Treatment Program to either continue or start MAT, call us at 612-444-3000 option 1 and one of our patient representatives can assist you to schedule the patient right away. Alternatively, you can complete our online patient referral form below or print a physical form (PDF format) and fax it to us at 612-444-9000.
Please indicate that this is for MAT services and we will schedule the patient's first visit within 72 hours.
We provide medication-assisted treatment (MAT) using proven medications like Buprenorphine or Naltrexone to help stabilize cravings and withdrawals. Patients are seen every 1-2 weeks when they begin treatment with intervals between visits increasing to every 3-4 weeks depending on stability.
1. Once we receive your referral we will contact the patient to schedule their consultation appointment with one of our advanced practice providers under the guidance of Dr. Svetlana Zaydman and Dr. Ashwin George.
2. Patients will receive our New Patient Packet to complete before their appointment date via our secure text messaging portal. Patients may also be asked to complete a Release of Information (ROI) Form for their other providers in order to have their most complete medical history prior to their consultation.
3. Our care team will evaluate the patient's medical history and perform a comprehensive evaluation to determine the best course of treatment to manage their condition, including but not limited to medication management, interventional procedures where necessary, individualized nutrition and exercise plans, lifestyle guidance, wellness services such as IV nutrient infusions to aid in better medication absorption, mental health medication management and counseling, and referral coordination for additional modalities as needed. You will then receive a summary of the patient's care plan.