Referrals

Some health plans have specific rules you must follow in order to be seen by a specialist. If your health insurance company requires a referral from a primary care physician, remember that it is your responsibility to provide us with the necessary referral information and documents. You must have this referral information with you during your initial appointment to be seen by the doctor.

Referral Form

Fill out the information below to request an appointment. Fields marked with an asterisk (*) are required.

Referring Physician Information

 

*Physician Name


 

Office Address


Street


City


State


Zip

*Phone

*Email Address

Patient Information

 

*Patient's Name


 

*Phone


Email Address

Patient's Diagnosis:

 

Physician:

 

Precision Spine Care is the only spine center in East Texas to be included in Spine Center Network, an exclusive national listing of credentialed spine centers of excellence. Click here to learn more.


Disclaimer: The pictures displayed in Precision Spine Care are images of physicians, patients and employees who have consented to have their pictures in this website. If you are viewing in Internet Explorer 8 or older you may need to update your browser by clicking here.