If your insurance company requires a referral from your primary care physician, please provide the clinic with all necessary referral information and documents. You must have this referral before seeing the physician.
Whether you are a physician or a patient, please fill out the appropriate form below. You can fill out the form online or print it as a pdf, fill it out and then fax it to: 731-668-6757.
- 1. Physician Requesting a Consult
2. Patient Requesting a Second Opinion