Get Cape Fear Urology Patient Forms

Filling out the Cape Fear Urology Patient Forms online is an essential step in ensuring that patient referrals are processed efficiently. This guide will provide you with clear and supportive instructions to navigate each component of the form effectively.

Follow the steps to complete the patient referral form online.

1. Press the ‘Get Form’ button to access the referral form and open it in the designated editor.
2. In the 'Please select the physician you are referring to' section, choose the appropriate physician from the list provided. Options include Nefertiti Childrey, D.O., Alden Reine, M.D., Hernando Salcedo, M.D., or the first available physician.
3. Fill out the patient information fields. Enter the full name, date of birth (formatted as m/d/y), and contact details including address, city/state/zip, office phone, home phone, and an alternate phone number.
4. Complete the referring physician section with your full name and practice, along with your office phone number. A signature is needed to authorize the referral.
5. Under the insurance information section, upload a copy of the patient’s insurance cards and any required authorizations. If the patient's name differs from that on the insurance card, provide the subscriber's name, date of birth, social security number, and their relationship to the patient.
6. Indicate the reason for referral and provide the diagnosis. If there are medical records to be sent, ensure they are noted as attached.
7. Finally, confirm that you have included any necessary medical records or tests. You will need to fax these to the office prior to the appointment. Take note of the appointment date, time, and the physician the patient will see.
8. Once all sections are complete, verify your entries, then save your changes and choose to download, print, or share the completed form as needed.

Complete your Cape Fear Urology Patient Forms online today!