Referrals Requirements

Neurospine is excited to offer FastTrac. We are committed to providing a streamlined evaluation process for your patients. If your patient has had an MRI in the last 6 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.

In order to provide the appropriate care and evaluation, we must receive patient health history records for at least the last 6 months along with any current imaging studies. 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 6 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) 686-3795