Healthcare Professionals

It is our pleasure to work with you in addressing the pain management needs of your patients in pain. We offer a vast variety of services including appropriate medication management, cutting edge interventional techniques and comprehensive plans of physical and psychological rehabilitation. Please do not hesitate to call us with any questions regarding your patients currently being treated at Silicon Valley Pain Management or otherwise. We look forward to our continued working relationship

SVPM Referral Form

Please send the following information to FAX # (408) 384-5121:

  •  Face sheet with patient’s demographic information
  •  Insurance information: Workers Comp/Private Insurance/Medicare (copy of both sides of card)
  • Insurance Authorization if needed (for HMO’s and Worker’s Comp)
  •  Last three months worth of Medical Records pertaining to the reason they are being referred
  • MRI Report / EMG Report / X-Ray Report / CT Scan Report, etc.

We look forward to working with you and your patient. We will call your patient very soon to make an appointment.

Sincerely,

Asmina Khan MD

Thank you for your referral!

What we offer

Services

Location
Silicon Valley Pain Management
4986 Cherry Avenue
San Jose, CA 95118
Phone: 408-645-6760
Fax: (408) 384-5121
Office Hours

Get in touch

408-645-6760