Referrals Requirements

Neurospine is excited to offer FastTrac. We are committed to providing a streamlined evaluation process for your patients. We are now providing imaging services to allow your referred patients to have a one-stop medical provider that can schedule MRI’s, and X-Rays so that they can be evaluated by one of our specialists quickly without sending them to another facility. If your patient needs an MRI simply send us a Referral and Imaging Order and we will get them scheduled. If your patient has had an MRI in the last 12 months, send the MRI report, Referral, and Patient Health History notes and we will have one of our surgeons determine if they are a candidate for surgery. If they are not, they can be referred to one of our Interventional Pain Medicine specialists for alternative treatment options.

In order to provide the appropriate care and evaluation, we must receive patient health history records for at least the last 12 months along with any current imaging studies. If imaging studies are not available, and MRI or x-rays can be provided at NeuroSpine. Most insurance companies require these records to authorization treatment coverage.

Referral Requirements:

  1. FastTrac Referral Form
  2. Health History Records (1-2 years)
  3. Available imaging studies within the last 12 months.

Note: If patient has had a previous lumbar surgery within the last 5 years, an MRI with and without contrast is required. In addition, if the patient is over 60 years old and an MRI with contrast is needed, a Basic Metabolic Panel must be ordered. We have an in-house lab to preform this order.


FastTrac Fax (541) 686-3793