For Referring Physicians

1. Complete the form below with the patient’s information.
2. Fax clinical notes to 404.499.0531

  • Date Format: MM slash DD slash YYYY
  • Mandatory fields marked *
  • Date Format: MM slash DD slash YYYY

If you are a PCP referring a patient, please be sure to generate and fax a referral prior to appointment. Thanks for allowing us to assist with your patient!