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Fax Instructions

Faxing Referrals

For more information about fax numbers, visit Contact Info, Referrals, and Consultations. For referrals, please fax the following information:

  • 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

  • Provider’s contact information, including name of office contact