833-339-7246
Patient Referral Form

Please fill out the form below or print and fax the “New Patient Referral Form” to (915) 257-6302.

Please enable JavaScript in your browser to complete this form.

Referring physicians are welcome to call us any time at 833-339-7246 with questions or concerns about a shared patient or to refer a patient to our care.

Download Referral Form
6955 North Mesa St.   
Suite 200
El Paso, TX 79912
1351 N Zaragoza Rd.
Building R
El Paso, TX 79936

(833) 339-PAIN (7246)
(915) 257-6302

© 2025 Villa Pain Institute