COVID-19 Update: We are seeing patients at our Edina pain clinic and through virtual visits. Safety Procedures

Patient Referral Form

To refer a patient, simply complete and submit the encrypted, HIPPA-compliant online form below.


A referral can also be submitted by printing and faxing a referral form to 763.537.6666. For general questions, please call us at 763.537.6000

If you have a patient struggling with chronic pain and you’d like to discuss the case, please call our PROVIDER HOTLINE AT 763-537-1000.

For urgent situations, we will do our very best to see your patient the same or next day. 

Once we receive the form, a Nura patient care coordinator will contact the patient and schedule an appointment. At a new patient evaluation appointment, our Medical Director, Dr. Peter Schultz, will see your patient along with an advanced practice provider, physical therapist, and a member of our behavioral health staff.

This multidisciplinary team then creates an individualized, comprehensive Plan of Care; this can include medication management, physical therapy, behavioral health counseling, and interventional procedures as necessary. At that point, we communicate the patient’s plan of care back to you.