Please complete the form below and a member of our team will contact you within one business day to schedule your appointment.

If you prefer to speak with us directly, please call our office:

Pittsburgh: 412-866-7246
Washington: 724-969-0191

If you are experiencing a medical emergency, please call 911.

Name
Please enter as MM/DD/YYYY (example: 07/14/1952)
Describe Your Pain Area(s)
Check all that apply
Example: Medicare, UPMC for Life, Highmark, Aetna, Workers’ Comp, Auto Insurance
Best Time(s) To Call
I consent to be contacted by Keystone Pain Consultants regarding scheduling and care.
I understand this form is for appointment requests only and is not intended for medical emergencies. If this is an emergency, I will call 911. I consent to Keystone Pain Consultants contacting me by phone regarding scheduling and care. I understand that information submitted through this form may be transmitted via email and may not be fully secure.
Please do not include detailed medical history, Social Security numbers, or highly sensitive information in this form.