Prospective Patients

If you would like to be seen by one of our doctors, we require a physician referral. Your current primary care physician, surgeon, or specialist physician can refer you to us.

To get a referral, follow these simple steps:

1. Download one of the referral forms below:

  • To be referred by your Primary Care Physician –

PCP Referral Form

  • To be referred by a Specialist/Surgeon Referral Form –

Specialist Referral Form

2. Take this form to your physician and ask them to fill it out and fax it to Michigan Interventional Pain Associates. Our fax number is 248-624-2597.

  • (We recommend asking your doctor to make you a copy of the referral form so you can bring it with you in case they have not faxed it over to us yet.)

3. Call us to make your appointment. Our phone number is 248-624-7246.

  • If you have any questions, please call us and we’ll be happy to explain in more detail or answer any specific questions you may have.

4. Please take the time to complete this new patient package prior to your appointment.

  • You can fill out the form online by following the link below:

New Patient Consult Online Form

  • You can also download all necessary paperwork for new patient registration. Please call clinic staff at 248-624-7246 to verify which PDF file to download:

Download New Patient Consult (PDF)

Please note: Adobe Reader is required to view PDF documents.