Spine Institute of New England Referral Information

The Spine Institute of New England provides the most advanced diagnostic services and treatment programs for any form of upper and lower back problem, including back and neck pain, arthritis, trauma/fractures, curvatures or spinal deformities, tumors, and degenerative conditions. 

TO SCHEDULE AN APPOINTMENT

Scheduling #:   
802-847-6000 
   
Main Office #:   
802-847-9005

Fax:       
802-847-6278

Location:   
Orthopedic Specialty Center
192 Tilley Drive
South Burlington, VT 05403

Office Hours:   
Monday, Tuesday, Wednesday, Friday, 8:00 am-5:00 pm
Thursday, 9:00 am-5:00 pm

Referral Information
This is information the Orthopedic Surgeon needs to provide the best care for your patient.

Medical/Surgical Information
Most Important
1.     Name of Referring MD/ Provider / Phone / Fax
2.     Reason for Referral and Expectations
3.     Problem List
4.     Medical/Surgical History
5.     Medication/Allergy List
6.     Most Recent Office Notes and Diagnostics (MRIs, EMGs, CTs, Myleo-CTs), Films and Reports Pertaining to the Referral.
7.     Previous Course of Treatment
8.     If the Referral is Worker’s Compensation-Related, send Worker’s Compensation Summary Defining why Referred and Desired Outcome

Please send the following information, if pertinent to the referral.
1.     Outside Consult Reports
2.     Operative Reports
3.     All Imaging Reports
4.     All Hard Copy Images
5.     Nuclear Medicine Reports
6.     Procedure Reports

Please send the following information, if relevant.
1.     Hospital Discharge and Medication Summaries
2.     Most Recent Pathology Reports

Diagnosis-Specific Information
1.      Trauma Patients: Please Send: ED Reports
         Results of all Pertinent Diagnostic Studies so Tests Do Not Need to Be Repeated.

Patient Demographic Information

Name, Date of Birth, Address, Phone Number, Insurance Plan, Worker’s Compensation Information, if applicable