OFFICE ADDRESS
Pain Specialists of Southern Oregon
825 Bennett Ave
Medford, OR 97504
(541) 779-5228
(541) 772-1533
REQUEST APPOINTMENT
All medical communications please use MyChart or please 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 needed from your primary care doctor, and authorization for medical records release.
This form is for general questions and information only. (Fill out completely)
