Requesting an Appointment for an Evaluation

If you are a new patient and would like to be seen for an evaluation, we need the following information from your primary care provider or other treating physician, using this Provider Referral/Request Form.

  • A written request for an evaluation
  • Include patient's name and contact information
  • Pertinent medical records related to the pain condition

The above information should be faxed to our office by the referring provider at 410-448-7150. Once we receive the above information, we will call to make the appointment.

  • Patients: Please call 410-448-6836 to speak with a New Patient Coordinator.
  • Referring Physicians: Please call 800-373-4111 with questions.

Assessment Form

Prior to your first patient appointment, please download and complete the Initial Pain Evaluation Questionnaire and bring it with you to your appointment.


We participate with a variety of insurance plans including Maryland Blue Shield, Medicare and many HMOs. Services requiring authorization are secured by our office staff. If a referral is required for the visit, it is the responsibility of the patient to secure this and bring it to the appointment. Patients without a required referral cannot be seen and will have to be rescheduled. Deductibles and non-covered services are the responsibility of the patient.

Patients will receive two bills for pain management services: one from University of Maryland Rehabilitation & Orthopaedic Institute for a facility fee and another for the physician's professional fee. Questions regarding professional fee bills may be directed to the Department Of Anesthesiology billing office at 667-214-1616. Questions regarding University of Maryland Rehabilitation & Orthopaedic Institute bills may be directed to 410-821-4140.

For more information or to make an appointment, call the University of Maryland Pain Management Center at 410-448-6824 or email us at