For Referring Providers
For healthcare professionals requesting a pain-management evaluation at our Tucson office.
Refer a patient for evaluation
Canyon Health, 5651 E Grant Rd, Tucson, AZ 85712. Call 520-326-7246 for current availability and referral questions. Office hours are Monday-Friday, 9 AM-4 PM.
- Complete the referral form. Identify the receiving clinic, referring provider, patient contact details, and reason for evaluation.
- Send the referral and relevant records by fax to 520-844-7092. When available, include the last three pain-management visit notes, recent imaging reports, the most recent relevant pain-management documentation, and a current medication list.
- Call to confirm receipt and next steps. A referral does not reserve an appointment or guarantee acceptance, treatment, or a prescription.
Download Fillable Provider Referral Form (PDF)
Open the PDF in your browser or a compatible PDF viewer. Fill it in, save a completed copy, and reopen the saved copy to confirm your entries. No Adobe subscription is required. You may also print the blank form and complete it by hand.
Self-pay office visits
Insurance is not accepted for office visits. Please advise patients of the self-pay policy and have them call for current consultation and follow-up fees. Clinical recommendations depend on an individual evaluation.
Protect patient information
Do not send completed referral forms or medical records through ordinary website forms, unsecured email, or text. Use the records fax above, or call for instructions. Text messaging is available for general scheduling questions only.
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This referral process is not for emergencies. Call 911 for an emergency.