Self-referrals are accepted at Louisiana Pain Care. You will be asked to provide office notes and X-ray/MRI reports from any other physicians who have previously evaluated your pain. These records must be submitted for physician review before an appointment can be made.
Please do not use this form if you have an urgent medical problem or you need to reschedule an existing appointment. Instead, contact our office at (318) 323-6405. After you submit your request, our appointment scheduler will respond within 48 hours. You can also download new patient forms to save time in the office. Established patients may log in to the patient portal to request appointments and update forms.
Please note that Medicaid is not accepted at this time.
Please Note: Any information submitted using this form is transmitted securely and held in the strictest of confidence, protecting your privacy.
Requesting an appointment via this form will be considered a self-referral. In order to have an initial consultation we will need the notes from your last three doctor’s visits, any radiology, MRI, or X-Ray that references the source of your pain, and a cover page with your name, contact information, and proof of insurance.
This information can be faxed to Fax: (318) 807-0205, dropped off at our Monroe location, or email to [email protected].