Botox

Diagnosis
Botox
Department
Comprehensive Pain Center; Plastic and Reconstructive Surgery; Pediatric Neurology

1. Start the referral process:

For adult referrals, use your own referral form or notes* or download our form:

For pediatric referrals,  refer to Shriners Tone Clinic.

2. Gather records:

For adult referrals at the Comprehensive Pain Center:

  • Detailed reason for referral and what is being requested to evaluate
  • Last 3 months of chart notes
  • CT/MRI/PT/xray or ultrasound imaging results

For adult referrals at Plastic & Reconstructive Surgery:

  • No records required

For Pediatric Neurology:

  • Refer to Shriners Tone Clinic

3. Fax the referral and all records to 503-346-6854.

* Referral notes or forms should include:

  • Patient name, date of birth, sex, address and phone number
  • Referring provider’s name, address and phone number
  • Diagnosis or reason for referral
  • Department patient is being referred to
  • Most recent chart notes supporting the diagnosis or reason for referral

For help or to arrange provider-to-provider advice, call 503-494-4567.

Date Revised May 16, 2022