Referrals | Complete Mid-South Coverage

To Schedule A Referral

1. To schedule by telephone, please contact us at 901.522.7700, then press 2 for the appointment staff.

2. To schedule by fax, download and complete the Fax Referral Form from the link below. Fax the completed form to us at 833.449.3605 along with the following information about the patient: demographic sheet, copy of the Health Insurance Card, treatment notes, and imaging reports.

3. C li ck h e re to book an a ppointment onlin e . Records and imaging reports may be faxed to 833.449.3605.

Referring physicians may request a same-day appointment by calling the main clinic line. Press 0 and ask to speak to our nursing supervisor.

901-522-7700

Resources

Download any necessary referral forms, or visit the Online Appointment Request Form.

Fax Referral Form

Download our Fax Referral form here
View PDF
EMG Referral Only Form

Download our EMG Referral Only Form form here
View PDF
Focused Ultrasound Referral Form

Download our Focused Ultrasound Referral Form form here
View PDF

To Schedule A Referral

Referring physicians may request a same-day appointment by calling the main clinic line. Press 0 and ask to speak to our nursing supervisor.

Resources

Fax Referral Form

EMG Referral Only Form

Focused Ultrasound Referral Form