Healthcare providers, we appreciate the trust you place in us when you refer a patient to our practice. For your convenience, we will contact the patient that has been referred to schedule an appointment at your request. Please fill out the form below and submit it, or print it and fax to 985-625-2200. Please be sure to include any recent diagnostic images and/or reports for the patient you refer. Our office will let you know the disposition of the patient following their treatment. Thank you again!