All new patients must be referred by a qualified health care provider (MD, DO, DPM, DC, PT, NP, PA ).

For Health Care Providers

If you are a referring provider and want to refer a patient to the Pain Management Division please print and fill out the Referral Form and fax it to (540) 450-2333.

For Patients

Your health care provider needs to make a referral first.  Once an appointment is arranged you will be sent a packet with information about the practice and important forms for you to fill out.  You can also download and print a copy of the forms below.

What You Need to Bring to Your Appointment

  • Completed Forms (forms are available below) 
  • Your insurance card and Rx card if applicable
  • Physician referral forms if required by insurance
  • A list of current prescriptions and/or over-the-counter medications you are taking, including dose and frequency along with the actual medications
  • A list of your questions and concerns

Please notify our office if you are taking any medication that would “thin” the blood (examples: Coumadin/warfarin, Plavix/clopidogrel, Ticlid/ticlodipine, heparin, Lovenox/enoxaparin, Arixtra/fondaparinux).

Patient Forms

Please print and fill out the appropriate forms below and bring them to your appointment.

Insurance and Payment Information

Virginia Brain and Spine Center is a provider for Medicare and most major insurance plans. We provide insurance billing.  We work hard to see all patients in need of pain management consultation regardless of financial status and insurance coverage.  Our financial planners can meet with patients to establish payment plans.  Anything not covered by insurance will be the patient's responsibility.  We request payment at the time of your appointment for services that are not covered by insurance.  Your insurance company may also require you to pay a co-payment at the time of your appointment.  When necessary, our staff will work closely with patients who require a payment plan.  If you have any questions regarding which insurance plans we accept or any patient billing concerns, please call us at (540) 450-0072.  Questions regarding your coverage and benefits should be directed to your employer or insurance company.

Participating Insurance Plans