The goal at Arizona Neurosurgery & Spine Specialists is to return our patients to as full function as surgery, treatment and rehabilitation will allow. For referring physicians, you can trust that we will provide precisely the level of care that you expect from your own practice, and that we will communicate clearly and consistently about your patient's status.
To make a referral, to inquire about the health insurance plans we accept, or to learn more about our specific neurosurgical services.
Neurosurgical Consult Request
We have provided a Neurosurgical Consult Request Form in a pdf format for your convenience.
IMPORTANT: PLEASE FAX to (602) 256-9581.
- A copy of the front and back of the Patient's Insurance Card
- Authorization or Referral
- All MRI, CT, EMG/NCV, Myelogram, Plain X-Ray Reports & last three Office Notes
Our office will contact the patient to schedule an appointment. We will return this form to your office with the appointment date/time noted below. Please do not send films prior to the consult. It is the patient's responsibility to bring their films to the appointment. If the patient does not speak English or Spanish, they must bring a translator.
PLEASE CALL OUR OFFICE FOR ADDITIONAL FORMS at (602) 254-3151