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Pain Conditions
Arthritis
Back Pain
Cancer Pain
Carpal Tunnel Syndrome
Chronic Pain
Complex Regional Pain Syndrome
Degenerative Disc Disease
Fibromyalgia
Foot Pain
Joint Pain
Knee Pain
Low Back Pain
Migraine Headaches
Neck Pain
Plantar Fasciitis
Sacroiliac Joint Pain
Sciatica
Shoulder Pain
Tension Headaches
Testicular Pain
Upper Back Pain
Services
Pain Treatments
Pain Medication Management
Auto Accident Treatment
Workers Compensation
Surgery Center
Telemedicine
Providers
Accepted Insurance and Costs
For Patients
New Patient Form
Records Release Form
ORT Survey
Referrals
Physician Referral
Attorney Referral
About Us
Our Story
Federal Way Location
Our Staff
Contact Us
Schedule An Appointment
Testimonials
Menu
Pain Conditions
Arthritis
Back Pain
Cancer Pain
Carpal Tunnel Syndrome
Chronic Pain
Complex Regional Pain Syndrome
Degenerative Disc Disease
Fibromyalgia
Foot Pain
Joint Pain
Knee Pain
Low Back Pain
Migraine Headaches
Neck Pain
Plantar Fasciitis
Sacroiliac Joint Pain
Sciatica
Shoulder Pain
Tension Headaches
Testicular Pain
Upper Back Pain
Services
Pain Treatments
Pain Medication Management
Auto Accident Treatment
Workers Compensation
Surgery Center
Telemedicine
Providers
Accepted Insurance and Costs
For Patients
New Patient Form
Records Release Form
ORT Survey
Referrals
Physician Referral
Attorney Referral
About Us
Our Story
Federal Way Location
Our Staff
Contact Us
Schedule An Appointment
Testimonials
Physician Referral
Home / Physician Referral
After filling out the information below, please email the following materials to
info@seattlepainrelief.com
History and physical or recent progress notes
Recent imaging, if applicable
Patient's Name
First
Last
Patient's Date of Birth
Patient's Phone Number
Chief Complaint / Diagnosis
Patient's Insurance Company
Aetna
Blue Cross Blue Shield
Cigna
First Choice
Humana PPO
Kaiser PPO
Labor and Industries
Life Wise
Medicare
Meritain
PIP
Premera
Regence
HMA
Tricare/Triwest
Uniform
United Health Care PPO
Workers Compensation
Other Insurance
Please select other if the insurance is not listed or self pay.
Other Insurancce
Referring Physicians Name
Referring Physicians Office Number
Treatment Options
Back Pain Treatments
Caudal Steroid Injection
Cervical Steroid Injection
Disc Denervation
Dorsal Root Ganglion Stimulation
Epidural Steroid Injection
Facet Injections
Ganglion Impar Block
Genicular Nerve Block
Hip Injections
Intercostal Nerve Block
Knee Joint Injections
Medial Branch Blocks
Occipital Nerve Block
Peripheral Nerve Stimulation
Piriformis Injection
Radiofrequency Ablation
Sacroiliac Joint Injections
Shoulder Injections
Sphenopalatine Ganglion Block
Spinal Cord Stimulator Implants
Stellate Ganglion Block
Supartz Series
Superior Hypogastric Plexus Block
Sympathetic Block
Trigger Point Injections
Trochanteric Bursa Injection
Whiplash and Back Injuries from Car Accidents
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