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

Reason For Referral

Evaluate and Treat For Pain Management
Procedure Only
Is there any existing Imaging for condition?

Please Submit The Following Documentation With Referral

Please note that appointment will not be schedule for the patient until our office has received All of the following listed below. This help to give our providers clarity too effectively and efficiently treat the referrad patient.

Demographic Sheet
Copy Of Insurance Card
Copy Photo ID
Most Recent Imaging reports
Most Recent Bloodwork
Current Medication List & Active Problems 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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