Colleagues, thank you for trusting us with the continuing care of your patient. We have developed two forms to help make the transition of information and records seamless and allow us to step in and begin care immediately.
For a new patient referral, please click here to download this form. New Patient Referral Form
For a procedure referral, please click here to download this form. Procedure Referral Form
Please fax the following information to (925)691-9807:
- Written order
- Recent visit notes, medication history and imaging
- Insurance and demographic information
- Authorization (if required).
We do require a written referral for all new patients.
Consultation Referrals – Ivory Santos | Direct: (925)482-8135 | E-mail: firstname.lastname@example.org
Procedure Referrals – Victoria Martinez | Direct: (925)482-8115 | E-mail: email@example.com
EMG/NCS / Med-Legal Referrals – Carrie Owen | Direct: (925)482-8131 | E-mail: firstname.lastname@example.org