LOCATIONS:

Pain Specialists of Southern Oregon
825 Bennett Ave. Medford, OR 97504

3555 Lear Way, Medford, OR 97504 (Starting Jan 3rd , 2022)

Main Phone: (541) 779-5228
Main Fax: (541) 772-1533

Our Team:
Joseph Savino, MD
George Johnston, DO
Brett Quave, MD
Daniel Kim, MD

Paul Leppart , ANP-C
Denise Partin, FNP-C
Jeremy Cathey, ANP-C
Eric Wruck, DC, FNP
Amicia Bullard, PA-C
Susan Rugh, FNP-C
Jared Thomas, FNP-C
Gregory Caldwell, PA-C
Ismael Vargas, PA-C
Carie Andersen, FNP,DNP

New Patient Packet Formulario de nuevo Paciente

REQUEST APPOINTMENT

All medical communications, please use MyChart or call 541-779-5228.

Your insurance carrier may require a referral from your Primary Care Provider as well as medical release forms, as a requirement for pre-authorization.

Use of this form constitutes your agreement to be bound by CareSubmit’s Terms of Use and Privacy Notice. Please note that your provider’s HIPAA privacy policies (contact your provider for a copy of its Notice of Privacy Practices) may also apply to information you disclose on this form. DO NOT USE THIS FORM FOR URGENT MATTERS. IF YOU ARE HAVING AN EMERGENCY, DIAL 911.

LEAVE A GENERAL COMMENT

All medical communications please use MyChart or please call 541-779-5228.
A referral is required from your primary care doctor, and authorization for medical records release.

This form is for general questions and information only. (Fill out completely)

 
 

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