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Refer A Patient
Referring Office Contact Information
Referring Physician
Phone Number
Email Address
Fax Number
If you would like a confirmation of your patient's appointment, please provide your fax number.
Please Check Specified Referral
Orthopedic Spine Surgeons
Travis L. Bailey, M.D.
Timothy A. Burd, M.D.
Jonathan E. Fuller, M.D.
J. Brian Gill, M.D., M.B.A.
Michael C. Longley, M.D.
John W. McClellan III, M.D.
Chase C. Woodward, M.D., M.P.H.
First Available
Neurosurgeon
John D. Hain, M.D.
First Available
Physical Therapy
Nick Collesano, P.T., D.P.T.
Amy Garrett, P.T., D.P.T.
Jaclyn Grevengoed, P.T., D.P.T.
Rachel Gusse, P.T., C.M.P.T., C.O.M.T.
Kelly Samson, P.T., D.P.T.
Rachel Witkovski, P.T., D.P.T.
Heather Wonderlich, P.T., C.O.M.T.
First Available
Physical Medicine and Rehabilitation Physicians
Scott Haughawout, D.O., C.I.M.E.
Jeremiah P. Ladd, M.D.
Matthew P. West, M.D., C.S.C.S.
First Available
Patient Information
Patient Name
Date of Birth
Patient Phone Number
Patient Alternative Phone Number
Patient Email Address
Patient Insurance
Symptoms & Diagnosis
Was this injury/condition related to workers' compensation?
Yes
No
Patient Has Completed
Bone Scan
Cast/Splint Applied
CT Scan
EMG
MRI
X-Rays
Requested Time to Be Seen
1 – 2 Days
3 – 5 Days
Our Team
Travis L. Bailey, M.D.
Timothy A. Burd, M.D.
Jonathan E. Fuller, M.D.
J. Brian Gill, M.D., M.B.A.
John D. Hain, M.D.
Scott Haughawout, D.O., C.I.M.E.
Jeremiah P. Ladd, M.D.
Michael C. Longley, M.D.
John W. McClellan III, M.D.
Matthew P. West, M.D., C.S.C.S.
Chase C. Woodward, M.D., M.P.H.
Specialties
Cervical Spine (Neck)
Thoracic Spine (Upper & Mid Back)
Lumbar Spine (Lower Back & Spine)
Pain
Locations + Services
Omaha (Main Office)
Columbus
Fremont
Grand Island
Lexington
Norfolk
South Sioux City
Bracing
MRI & CT Scans
Physical Therapy
Workers' Compensation
X-Ray
Patient Resources
Surgical Presentations
Spine Education
Conditions of the Spine
Nonsurgical Care and Management
Surgical Care and Management
Telemedicine
Success Stories
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