Refer a Patient

Referral Form

We appreciate the trust of healthcare providers.  If you are a referring provider who is sending over a referral, please download the attached form.  An alternative is to call our dedicated referral line at (270) 228-0119. Thank you again for trusting us with your patients!

Referral Form PDF
Please complete and fax this completed referral form along with the patient’s demographics, pertinent clinic notes, imaging records and insurance cards to

Fax: (270) 228-0120