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Patient Referral Form

Please use this form to refer a patient from your practice to Sonoran Spine. Complete all of the information requested in the form below. Please note that the asterisk (*) items are required to complete your referral request. Once your referral has been submitted, we will contact the patient within 24 hours (Monday – Friday) to schedule an appointment.

Referring a patient for a work related injury? Use our Workers’ Compensation Appointment Form.

We look forward to continuing to provide the expert care you have come to expect from Sonoran Spine.

Referring Physician Office Information
Patient Information
Medical Information

Please note that not all providers are available at every location. We will follow up with patients regarding their provider and location preferences.

Top Doc Awards

Black Canyon City *New Location* 
19251 E. Oasis Dr, Black Canyon City, AZ 85234

Gilbert *Updated Address*
3717 S. Rome St. Ste 106, Gilbert, AZ 85297

Glendale 
5681 W. Beverly Ln, Ste 101, Glendale, AZ 85306

North Phoenix *New Location* 
33300 N 32nd Ave, Ste 101, Phoenix, AZ 85085

North Scottsdale (Thompson Peak) 
20401 N. 73rd St, Ste 155, Scottsdale, AZ 85255
 

Scottsdale (Shea) 
9700 N. 91st St, Ste B108, Scottsdale, AZ 85258

Show Low *Updated Address* 
4951 S. White Mountain Rd, Building A, 2nd Floor,
Show Low, AZ 85901

Queen Creek *New Location*
37200 N. Gantzel Rd., Ste 240, Queen Creek, Arizona 85140

Tempe 
1255 W Rio Salado Pkwy, Ste 107, Tempe, AZ 85281