fax from your emr


Please be sure to include:

  • Patient name and DOB
  • Their best contact information
  • Reason for referral
  • Requested consult and/or procedure(s)
  • Recent or relevant notes, labs, radiology reports
  • Insurance information 

use referral form

Use this fill-able PDF referral form. Complete, print and fax or fax directly from your computer.

call us


Tell us about your patient.

Do you have a question or a case you would like to discuss?

Please leave a message with Rachel. Dr. P will do his best to return your call before the end of the work day.