This form is only for referrals of new patients. If you are an established patient looking to update your information in our system, or looking to request an established patient appointment, please call our office at 256-883-2112.
ATTENTION: When filling out this online referral form PLEASE attach the necessary medical records by using the file drag and drop option at the bottom of the form. If you are unable to do this, please fax the necessary medical records ASAP to 256-885-0037. Failure to do so will result in a delay of care for your patient.