Thank you for choosing us to participate in your patient’s dermatological care needs! If you are a provider or representative of a provider office and wish to submit a referral, please click the most appropriate form below then fax to our office. Please note we are only able to schedule patients with Medicaid health insurance at our Lexington and Richmond locations.
- Referral Form submitted to our office electronically or via fax 859-276-3373.
- Please be sure to include CURRENT patient contact information and demographics (preferably a face sheet). If available, please attach a copy of the patient’s current health insurance card, a copy of the patient’s driver’s license/ID, and supporting documentation for the referral. Please limit supporting documentation to ONE (most recent) visit note, pathology, and lab studies related to the referral.
- Please be aware that if a specific provider is indicated on your referral form, we will attempt to accommodate your request but please be aware that requests are NOT guaranteed.
- Our office will contact the patient (or patient representative) directly to schedule an appointment based on availability and order referral was received. Please allow up to 14 business days for our staff to review the referral and schedule the patient, after the initial referral was submitted.
- After the appointment/referral has concluded, we will fax a copy of the visit summary to the referring provider with 72 hours of finalizing the visit.
Click the link below to select the most appropriate Referral Form for your patient: