Physician Referrals Referring A New Patient

Tri-County Pain Consultants appreciates the referral of your patient with Pain. We want you to know that we intend to work with you and your patient together in finding relief for their Pain.  We will do everything possible to make sure the lines of communication are open and clear regarding the treatment and progress of your patient. If you would like to refer a patient to Tri-County Pain Consultants you have a few options.

  1. You can call (248) 735-8272 and a scheduler will set your patient up with an appointment.
  2. You can fill out the form below and give us a few pieces of information and we will call the patient to set up the appointment for you and call you back to let you know the date the appointment is scheduled, for your records.*
  3. If you prefer to utilize our Fax Referral, you may fax your request to 248-735-7276 or contact TCPC Referrals. We will personally drop the forms off for you and answer any questions you may have about the process. If you like you may also fill out the form below, print, and fax it over to us at 248-735-7276*
*These processes are designed to save you and your busy office staff time on the phone. With both online referral and fax referral we can get you off the phone in just a few short minutes.
Online Patient Referral Form

Fast Track Scheduling

TCPC Scheduling
Phone: (248) 735-8272 Fax: 248-735-7276   Email: physician referrals


Additional med recs can be emailed to address above or faxed to 248-735-7276, please do not fax referral requests to this number. All referral requests should be faxed to 248-735-7276.

To print a copy for your records, fill out then hit File > Print, from the File Menu before you select ‘Submit this Form’.

Please complete this form and click ‘submit by email’ above. Our scheduling department will call the patient to set up appointment and then call you to let you know appointment has been set. Red asterisk indicates required information. Thank you for the referral.