If you are a physician wanting to refer a patient we need the following information sent to our office:

1. Reason for Referral
2. Current Medication List
3. Medical History
4. Allergies
5. Surgery List
6. Social History (Please include smoking status)
7. Family History
8. Labs/Scans/Tests pertinent to diagnosis
9. Growth Chart (Pediatric Referral)
10. Last Progress Note
11. Demographics/Insurance Information

Once the information is received, it will be sent to the physicians for review. Upon review our
schedulers will call the patient to schedule and fax your office with the date of the scheduled