Referral Coordinators

Knoxville
1346 Papermill Pointe Way,
Knoxville, TN 37909
knox@APSpaincenters.com

To Schedule your referral by phone call:
Knoxville
865-219-3506

Medical Records
Tiffany Ivey (865) 558-6939

Johnson City
818 Sunset Drive suite 102
Johnson City, TN 37604
johnsoncity@APSpaincenters.com

To Schedule your referral by phone call:
Johnson City
423-207-2267

Medical Records
Angela Hixon (423) 794-3142 ext 109

Referral Form

Complete Authorization Form

Evaluate and Treat For Pain Management
Medication Management
Procedure Only

Requesting Procedure

Interlaminar and Transforaminal Injections
Radio Frequency Ablation
Joint Injection
Hip Injection
Sympathetic Block
SI Injection
Trigger Point Injection
Spinal Cord Stimulator Trial
Other

Please Submit The Following Documentation With Referral

Demographic Sheet
Most Recent Office Notes
Copy Of Insurance Card
Most Recent Imaging reports
Workman's Comp Information
Copy Photo ID
Current Medication List

Request Appt Date And Time

Referral provider signature

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Make An Appointment

Your Name

Your Email

Your Phone

Subject

Your Message

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