Ethical and Professional Standards
and Professional Standards
Please give this form to each recommending physician.
Two (2) letters of recommendation from practicing physicians must be submitted on behalf of each applicant for certification.
Both letters must be from physicians who can speak to the applicant’s practice in
Pain Medicine. ONLY ONE (1) letter may be from a physician partner. The second letter MUST be from another physician who can speak to the applicant’s practice in pain medicine. Letters from relatives will not be considered.
1. The letter must be TYPED on the letterhead of the recommending physician and
Should be mailed to:
Monique Steegers, MD, PhD, FIPP
Registrar of Examination
World Institute of Pain
150 Kimel Park Drive, Suite 100A
Winston Salem, NC 27103-6984
Phone: 1.336.760.2939 - Fax: 1.336.760.5770
2. The letter must be addressed:
Dear Credentials Committee,
3. ALL letters must contain the following information:
a. Name of applicant.
b. Number of years and in what capacity the recommending physician has known the applicant.
c. A statement about the applicant’s competence in the field of Pain Medicine.