Referring physicians:

1.   Please print out the form below:

• Patient Referral Form to University of Rochester Pain Treatment Center

2.   Fill in and fax or mail to:

University of Rochester Pain Treatment Center
180 Sawgrass Drive Suite 210
Rochester, NY 14620
Voice: (585) 242-1300
Fax: (585) 473-5007

Please include relevant clinic notes and diagnostic study results.