Thank you for allowing us to participate in your patient’s care! After completion of both forms, please fax to 919-966-3414 including copies of patient’s records. Upon receipt, we will notify you with date and time of appointment and will forward the necessary information to the patient.

To download the Patient Referral Form, Click here.

To download the Patient Referral Form for the Greensboro Clinic, Click here.

Department of Medicine
CB# 7584, 8015A Burnett-Womack Bldg.
Chapel Hill, NC 27599-7584
Phone 919-966-2516 – Fax 919-966-3414