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.
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.