Intrathecal Pump Referral

Provide the details below to refer your patient for intrathecal pump evaluation and management. Our team offers expert, compassionate care to help patients achieve optimal pain relief and improved quality of life.

Intrathecal Pump Referral

Referring Office Contact
Primary Intrathecal Pump Physician
Patient Information

Please fax the following documentation to Turning Tide Health at (703) 637-3586

  1. Demographic Face Sheet *Including Full SSN or Driver's License & Emergency Contact
  2. Telemetry / Implant / IT Pump information *including low alarm date
  3. Clinical Note with Allergies, medications, and diagnosis code(s)
Patient Referral Comments