Referrals

A physician referral is necessary to schedule an appointment at the U-M Back & Pain Center. If you are a physician and wish to make a referral, please look to the information below.

If you are a patient and wish to receive a referral, please have your primary care provider complete a Request Form and fax it, along with other relevant records as listed below, to us at 734-936-6585.

In complex cases, we will review a patient’s medical records before scheduling an initial consultation appointment. Therefore, all physicians must send the following items, where relevant:

  • Copies of medical records and/or clinic notes
  • CT scan and/or CT myelogram results and images
  • EMG results
  • Insurance information
  • Lab results
  • List of current medications
  • MRI results and images
  • Previous pain management notes (clinic and procedural)
  • X-Ray results and images

Internal Physician Referral Process
If you are a U-M physician, please fill out a referral in MiChart.

External Physician Referral Process
If you are a physician outside U-M, please download the Request Form and fax the completed form to us at 734-936-6585.

Please call us at 734-615-7246 MTWF 7:30 a.m. – 4 p.m. or Th 8 a.m. - 4 p.m. with any questions or concerns.