1- Print the Referral Form:
2- Fax the filled Referral Form to 757-264-6270
We will contact the patient promptly and schedule the appointment.
Referrals can also be made by telephone:
Please call our office at 757-821-2095
To expedite your patient’s visit, please advise him/her to have the following information available for their appointment, or have your staff fax any available records with the referral form:
- Completed patient forms (please PRINT FORMS , and fill out before your visit)
- Valid photo ID
- Current insurance card and information, and any co-pay or deductible due
- Records and provider notes of any previous treatments for this condition
- Previous imaging studies on a CD or film, with printed radiology reports (X-Rays, CT scans, MRIs, Bone Scans, EMG/nerve conduction studies, etc)
- Name of referring physician
- Name of Primary Care Physician
- Referral for HMO patients (if required)
- Workman’s Comp referral, claim number and adjustor’s name
Referring Physician Toolkit
Please fill out the form below and click submit.
We Respect Your Existing Patient Relationship
We understand that you have invested time and energy into building your relationship with your patients, and we recognize our role as a helpful consultant who enhances that relationship.
We Get Timely Results
We schedule patients to be seen promptly. Once we have the necessary preliminary information about your patient’s case, we will order testing and plan for follow-up. We pride ourselves on prompt and accurate diagnosis so that we can move ahead with a treatment plan as soon as possible.
We Report Promptly
You will receive a faxed note very shortly after we see your patient, and we will continue to keep you updated on a regular basis during the course of care. We are happy to follow up with a phone call the same day we see your patient if you request such contact.