Download Our Referral Form

Thank you for entrusting us with the care of your patients. We understand how important quality healthcare and patient satisfaction are to you as we value those same qualities. We sincerely appreciate the trust you have placed in us.

Because we work through physician referrals, it is vitally important to receive all necessary paperwork before we can schedule and appointment for your patient. Please complete our Referral Form and fax to (318) 212-7333 along with the below information. If you need a copy of our Referral Form, please call or E-Mail our New Patient Coordinator's

  • Patient face sheet
  • Imaging reports, if available
  • Any relevant records

If any imaging was done outside of Willis-Knighton, please remind your patient to pick up their imaging disk and bring to their first appointment.

Once all pertinent information is received, our New Patient Coordinator’s will review it and send to the Physician for approval. We will notify your office with the outcome.

For patients interested in an Initial Consult for Interventional Pain Management, a Referral may not be required initially. The appointment would be for evaluation only & Narcotics will not be prescribed at this visit. If Narcotics are considered in the treatment plan, the patient will need to obtain a Referral from their physician.

Referrals are typically processed and sent to the physician for review within 24-48 business hours. The physician review process can take up to 1 business week. If your referral is approved, our New Patient Coordinator will contact you within 1 business day of the approval. If your referral is not approved, your referring provider will be notified, and you will need to contact them directly for details and/or information on how to proceed. Unfortunately, our office staff will be unable to provide this information to the patient directly. 

Please do not hesitate to call our New Patient Coordinator’s at (318) 212-3636 or email if you have any questions.

Download Our Referral Form

Willis Knighton Health