New Patient, Patient Self-Referral Form

Welcome to Pacific Spine Specialists!  We value your time and look forward to helping you. The most effective way for us to do so, is for Dr. Keenen and Dr. Hiratzka to review your MRI scan and for the New Patient Coordinator to speak with you about your symptoms.

You may begin by first phoning the New Patient Coordinator at 503-885-9391, or filling out the form below.

  • Appointment Scheduling

    Our New Patient Coordinator will contact you within 24 hours. Patients may also call us at 503-885-9391.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Symptoms

  • Spine Studies and Injections:

    We will arrange to have your studies transferred to our office. Please fax any copies of imaging reports you may have to our office.
  • Medical Insurance / Workers Compensation (WC) / Motor Vehicle Accidents (MVA)

    We are experienced at evaluating and treating work and motor vehicle injuries.