Thank you for using Pain Management Associates to help your patients find relief from their pain. At Pain Management Associates, we deeply value our partnership with referring physicians.


Please provide the following and we will contact your patient to schedule your appointment:

Patient Name *

Patient Date-of-Birth

Your Email *

Patient Phone Number


If you would like to expedite the referral process, please answer the following:

Has the Patient had Imaging Done
 Yes No

What are the Patient’s Allergies

Please attach the demographic sheet and the most recent doctor’s note:

Your Additonal Message

At Pain Management Associates, we pride ourselves on our communication with referring primary care physicians. If you would like to offer feedback on this area, please utilize our Feedback Form.

To help us better understand your communication preferences, please fill out our Physician Referral Preference Sheet.

We enjoy networking with our local primary care physicians. If you would like to contact us to arrange a time for us to visit your office, please contact us at 434-975-255 and ask for Jenny. Some of the informative sessions we offer:

    • Narcotic Management
    • Diagnosing Upper-Body Injuries
    • Interventional Pain Management
    • Reflex Sympathetic Dystrophy Syndrome
    • Dealing with Chronic Pain