---
title: Chiropractor to Pain Management Physician Referral Form Template | Paperform
description: Professional referral form for chiropractors to refer patients to pain management specialists. Capture spinal manipulation outcomes, chronic pain history, opioid tolerance, and interventional procedure candidacy.
url: "https://paperform.co/templates/chiropractor-to-pain-management-physician-referral-form"
type: static
generatedAt: "2026-03-28T00:43:18.790Z"
---

[← Back to free form templates](/templates/)    ![Chiropractor to Pain Management Physician Referral Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/chiropractor-to-pain-management-physician-referral-form.png)
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### Streamline Patient Referrals from Chiropractic to Pain Management

When conservative chiropractic care reaches its limits, a smooth handoff to a pain management specialist can make all the difference for your patients. This **Chiropractor to Pain Management Physician Referral Form** is designed to capture the clinical details that matter most—spinal manipulation outcomes, chronic pain duration, medication history, and candidacy for interventional procedures—so pain management physicians can hit the ground running with a complete patient picture.

#### Built for Collaborative Care Between Chiropractors and Pain Specialists

This template helps chiropractors document treatment history, functional limitations, imaging findings, and red flags in a structured format that pain management teams actually need. By capturing opioid tolerance, prior injection history, psychosocial factors, and specific procedure candidacy, you're setting your patient up for faster evaluation and better outcomes.

Paperform makes it easy to customize fields for your practice's workflow, embed the form on your website, and automatically route completed referrals to the right specialist via email or your practice management system. You can even use conditional logic to show or hide sections based on pain location, treatment response, or urgency level.

#### Automate Referral Workflows with Stepper

Once a referral is submitted, you can use [Stepper](https://stepper.io) to automatically notify the pain management clinic, log the referral in your EHR, send a confirmation to the patient, and trigger follow-up reminders—all without manual data entry. This keeps your care coordination seamless and ensures no patient falls through the cracks.

Trusted by healthcare providers worldwide and SOC 2 Type II compliant, Paperform helps chiropractic and pain management practices deliver coordinated, patient-centered care with less administrative burden.
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