REFERRAL FORMS

The links below will open as PDFs that you can download, read and print. If the document you download is a form, please print it out, fill in the information, and fax it to Athens Spine Center at 706-425-2410.

Guidelines for Referrals
Consult Request
Authorization for Disclosure of PHI
(Medical Records Release)
Authorization for Disclosure of PHI
(Medical Records Request)
Patient Request for Treatment Release

To Our Referring Physicians

Your referrals indicate your confidence in the treatment your patient will receive from our practice. Your patients are welcomed by our friendly and proficient staff to a pleasant environment and private office setting. We offer a conservative clinical approach to achieve positive long term results for your patient. Every effort is made to communicate with you and keep you continuously updated with each patient encounter. We appreciate the opportunity to provide interventional pain management services for your patients.