If you have never been seen by a physician in the esophageal center, your doctor must fill out the referral form by downloading it (below) or by calling 919-966-2513 and requesting the referral form. In order to provide quality care, pertinent medical records and a copy of your insurance card will need to be included with the form. You will be notified of the date and time of the appointment. Health Care Providers:
Thank you for allowing us to participate in the care of your patient! Please fax completed referral forms to fax# 919-843-2508 including copies of pertinent medical records and insurance information. We will notify you with date and time of appointment.
To download the Patient Referral Form for a clinic appointment, Click Here