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Referrals

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.

Forms

1. 1. Physician Requesting a Consult
   2. Patient Requesting a Second Opinion