We Thank You!

The medical insurance referral form for the physicians can be downloaded here or by clicking on the link to the right on this page.

Referral form for the patients that are covered by Workers Compensation Insurance can be found here or by clicking on the link to the right on this page. We will contact the Workers Compensation Insurance case worker in order to get prior authorization to see the patient.

Referral form for the patients that are covered by Personal Injury Protection/ Auto Accident Insurance can be found here or by clicking on the link to the right on this page.

Referring office is asked to mail or fax medical records, demographic form, copies of the front and back of the insurance card as well as recent X-rays or MRI reports pertinent to patient’s problem directly to our office:

If the medical provider would like to have a supply of our referral pads on hand, please feel free to call our office and we will mail them to you that very day.

Completed initial consultation report will be mailed or faxed back directly to the referring medical provider’s office the very same day the patient is seen. In the unfortunate case when the patient has to be dismissed from our practice (such as in the instance of failed urine drug screen), Dr Igor Smelyansky will personally call the referring provider and will explain the situation directly. This way there is no misunderstanding between our clinic and the referring provider and it keeps the lines of communication between offices open.

We are looking forward to establishing a long-term relationship with your office for many years to come.
Thank you for choosing Omega Pain Management !