For referring providers
Referring a Patient to Our Surgeons
Our surgeons welcome referrals from physicians across Mississippi. Referrals are accepted by fax or email.
Download the Physician Referral Form
Download and complete our fillable PDF referral form, then return it to our office by fax or email.
Download Fillable Referral FormAfter completing the form, save a copy to your device and send it using one of the secure referral methods listed below.
How to refer
Send a referral by fax or email
Referrals are accepted by physicians only
This website does not accept, submit, or manage referrals, and there is no upload feature here. Please send referrals directly by fax or email. Sending a referral does not by itself guarantee acceptance, scheduling, treatment, or the creation of a physician-patient relationship.
Helpful information to include
- Patient name, date of birth, and current contact number
- Referring physician name, practice, and callback number
- Reason for referral and relevant history
- Recent imaging, pathology, and laboratory results
- Insurance information and any authorization already obtained
- Urgency, and whether the patient has been advised to seek emergency care
Questions about a referral
To confirm receipt of a referral or discuss an urgent case, call our office at (601) 948-1411 during office hours (Mon–Thurs 8:00 am – 4:30 pm · Fri 8:00 am – 1:00 pm).
Coordinating a patient's surgical care?
Our staff can confirm that a referral arrived, help with scheduling, and answer questions about what our surgeons treat.