Horizon Headache
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Make a Physician Referral


Self-Scheduling by Patient

Give patient a written prescription with your consultation reason and have them call to schedule an appointment at 859-263-2222.


Online Referral

Fill out the form below and we will contact your patient within one business day to schedule their appointment.

Patient Name:

Patient Phone:

Referring Physician:

Reason for Consultation:


Printable Referral Form

Click here to download a printable version of our Referral Form (PDF)

Fill out printed copy and either give it to your patient to self-schedule an appointment or fax directly to our office at 859-263-0020 and we will contact your patient.


Same Day Acute Referrals

Call 859-263-2222 for a same day appointment time. Our physician will return your call shortly to discuss your patient's case with you, at your request.


Horizon Headache Center