*******PLEASE SEND COPY OF INSURANCE CARDS (front and back)*******

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Thank you for the referral.

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To assist in the ease of the referral process for the patient please provide the following information along with the relevant medical records by fax to 205-716-6212

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• Demographic Information

• Relevant Progress Notes

• Most recent Lab Results

• Diagnostic Results (CT/MRI/Mammogram/Colonoscopy, etc.)

• Any other test reports relevant to the patient referral

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PLEASE MAIL TO OUR OFFICE OR SEND WITH PATIENT ANY FILMS/CDs of DIAGNOTIC TESTS TO OUR OFFICE TO ENSURE WE ARE ABLE TO ADDRESS THE PATIENT’S REFERRAL NEEDS THE DAY OF THE APPOINTMENT.  PLEASE FEEL FREE TO CALL IF THERE ARE ANY QUESTIONS.

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If the patient’s insurance requires a referral, please include the referral authorization.