Online Contact Form

Use this form if you have non medical questions related to scheduling an appointment, billing questions or if you are a physicians office and would like more information about our practice. Patients interested in setting up a non urgent new patient appointment may do so by using this online form.
Allow at least 2 business days for response to your inquiry. Thank You!
CONTACT INFO

Date:    Office Name :(if from a physicians office) 
Full Name: Phone Number (needed in case email not working):
Fax Number: Email:
Inquiry Regarding: Preferred method of response contact:

Please click here to confirm that you have read and agree with the below disclaimers: (required)

Conditions of Online Contact Form:

Southern Michigan Pain Consultants values your privacy. We have taken all reasonable precautions to ensure that your information is securely transmitted. This contact form should be used for routine purposes only, if this is an early or urgent refill call the refill line and leave a message for the nurse to contact you back. Refill phone numbers:

  • Portage Rx Line (269) 329-2446
  • Marshall Rx Line (269) 781-4913
  • St. Joseph Rx Line (269) 429-3865

These forms are downloaded on a daily basis Monday - Friday. You can expect a response to your question within two business days of the form being submitted.

This form is for general non urgent issues. To schedule a follow up appointment you will need to call the location you are seen at to have these issues addressed.
Main office number below:

  • Portage Direct: (269) 329-2887 or toll free (866) 647-2461
  • Marshall Direct: (269) 781-3561
  • St. Joseph Direct: (269) 429-3865