Physician Referrals

This page is for the use of ONLY PHYSICIANS & MEDICAL PROFESSIONALS for the purposes of referring patients to MD Pain Care. All information sent through this form will be treated with complete privacy and discretion. We will follow up with you to confirm that we have received this referral form. If you have not heard from us within 24 hours please call our office at 770-760-9360. Thank you!


Download Patient Referral Form