Header Graphic Header Graphic
For Health Care Providers
Referral form



If you are a doctor, a health care provider or a doctor's representative, you can download and fax the "referral form" below to 281-998-3331. We will immediately make all the necessary arrangements directly with your patient and keep you informed. If this method is inconvenient, please fell free to use our online submission form found in the "contact us" page; please indicate that you are a doctor's office on the box provided for comments. Thank you.

Referral Form (for Health Care Providers ONLY)

CLINICS POLICY ON REFERRALS. We prefer our patients to be under the oversight of a Primary Care Physician whenever possible. If the patient does not have a PCP, we generally assist him/her in obtaining one. One of our MAIN goals is to assist the primary care physician in providing a consultative (evaluation/management) service consisting of an assessment of the causes (i.e, identification of pain generators) and mechanisms of the patient's pain and then provide the treatment (interventional or non-interventional). Thereafter, patients are generally referred back to their primary care physician with detailed guidelines for long term management, UNLESS we are requested to manage the patient's pain on long term basis. Our general preference is to provide evaluation, initial treatment and a consultative report to the primary care physician for long term management.

We also accept referrals with specific instructions to perform a particular procedure from specialists and primary care physicians (i.e., spinal cord stimulator trial, vertebroplasty, selective nerve root block, etc.) Please request this specifically in the referral form.


Discogenic Pain | Degenerative Disc Disease | Herniated Disc | Nucleus Pulposus | Spinal Stenosis | Spondylolysis |   Spondylosis | Fibromyalgia Syndrome | Osteoporosis | Vitamin D Deficiency | Sacroiliac Joint Dysfunct | Sciatica Pain | Chronic Pain Management | Epidural Injections | Joint Injections | Facet Joint Injections | Discography | Prolotherapy | Physical Therapy | Trigger Point Injections | Neck Pain | Platelet Rich Plasma


HOUSTON: 2646 S. Loop West Fwy. Suite 104. Houston, Texas 77054. Phone: 713-661-0300
PASADENA: 5413 Crenshaw, Pasadena, Texas 77505

Miguel Pappolla included in America's Top Physicians REQUEST AN APPOINTMENT (we will contact you within 24 hr. or on Mondays for appointments made on weekends) 




2011-2017 © Copyright. All Rights Reserved Houston, Texas