Refer a Patient
We welcome referrals from provider clinics and value the opportunity to collaborate in patient care. Please use the secure form below to refer your patient to our clinic. The process is quick and simple.
Provider Referral Only – Not for Emergencies
This secure referral form is intended for use by healthcare provider offices to refer patients to Neuro Heart and Vascular Clinic for evaluation and ongoing care. It should not be used by patients or family members for self-referrals or medical questions. Please do not use this form for medical emergencies or time-sensitive issues. For emergencies, call 911 immediately. For urgent questions about an existing patient, please call our office at 865-444-6161 instead of using this form.
Privacy and Patient Information
By submitting this form, you confirm that you are an authorized member of the referring provider’s office and that the patient has consented to this referral and to the sharing of relevant medical information for the purposes of coordination of care with Neuro Heart and Vascular Clinic. Please provide only the information necessary to process this referral. Neuro Heart and Vascular Clinic takes patient privacy seriously and protects health information in accordance with applicable privacy laws. However, email is not a secure method of communication. Please do not send sensitive patient information or medical records to us by regular email. Instead, use this form or other secure methods agreed upon between our offices. This referral form is not monitored for emergencies or after-hours clinical issues. For medical emergencies, call 911. For urgent clinical questions, please call 865‑444‑6161.
Questions?
If you have any questions about referrals or need assistance, feel free to contact us at [email protected] (Please do not include sensitive medical information in email) or call us at (865) 444-6161
