Referring Doctors

Dear Referring Physician,

• If you are referring a patient to us, please provide:
• Your contact information
• A referral for the visit
• All visits require a referral for nasal endoscopy (CPT code 31231/31237)
• A copy of sinonasal XRAYS / CT scans (both films and reports)
• Copies of records related to the patient’s sinuses/nose/allergies/lungs.

Thank you for your referral!

Please prepare your patient for their visit by bringing:

• A picture I.D. and your health insurance card/information.
• The co-pay required by your insurance carrier.
• Please check with your insurance carrier to determine if a referral is required for a clinic visit with us.
• If you have HMO insurance, you must have a referral for this visit.
• If you have HMO insurance, you must also obtain a referral for nasal endoscopy (CPT code 31231/31237)
• Your referring physician’s or primary care physician’s name and contact information.
• A copy of your XRAYS / CT scans (both films and reports)
• Copies of records from doctors related to your sinuses/nose/allergies/lungs.
• A list of all medications you are taking
• Completed forms

Your patient may also want to have:

• A list of your questions /concerns
• A friend or family member to take notes/help with questions
• If you are 30 minutes late for your appointment, it will be rescheduled. 
• If you are unable to keep this appointment, please provide 24 hours notice.