Faxing Referrals

For specialty care, surgery or procedure referrals, please fax the following to 888-539-8781:

  • Patient contact information: name, address, phone number, date of birth
  • Copy of insurance card (front and back)
  • Insurance authorization, if required
  • What service is requested (consultation, diagnostic testing, etc)
  • Please give specific provider’s name if requested/known
  • Diagnosis, reason for referral
  • Copies of progress notes, diagnostic test results that pertain to this visit, including CPT and ICD-9 codes
  • Provider’s contact information, including name of office contact

For more information, see Transfers, Referrals and Consultations.