Refer a patient.

Thank you for considering Westport Pain & Performance for your patient. Our team reviews referral requests and contacts patients to discuss available care and next steps. Our Westport, CT office opening is planned for July 1, 2027.

We know you're placing trust in us with your patients. We'll do everything we can to provide the most value and care for them.

How it works

You submit the form - patient name, email, and phone, plus who you are. No clinical notes here.
Our team reaches out - we contact the patient to confirm service availability and scheduling.
We provide care - interventional pain management and related services as clinically appropriate.
You get a consult note - a detailed note sent back to you after the visit.

This form is for referral outreach only. Do not include diagnoses, records, or insurance IDs.

Refer a patient

Submit the referral.

We'll reach out to the patient, take care of them, and send you a detailed consult note.

Patient

Patient first name

Patient last name

Patient email

Patient phone

What are you referring for?

Referring clinician

Your name

Practice / role

Your email (optional)

Your phone (optional)

We'll reach out to the patient to schedule. Not for emergencies - call 911 for urgent concerns.