To save time at your first visit, download and complete the following forms ahead of time, and we'll get you started even faster. Find Relief without a Referral.With many insurance plans, no prescription or doctor's referral is needed to start your journey to a pain-free life. Please fax Client Referral Form to: (817) 850-2307. For additional information call: (817) 413-6320. Employee and the Company are entering into this Agreement to set forth the terms and conditions of Employee's employment with the Company or its affiliate. We strive to provide cost-effective travel insurance solutions for all travelers. However, cervical spine impairment has been reported to refer pain to the ear or throat. Ethnicity of Target Areas. Physical therapy, podiatry, speech pathology, and the clergy.