Call one of our offices directly and request a scheduler. Please call one of our Kansas City metro offices at (816)931-1883 or in Lawrence, (785)841-3636.

Fax the completed referral form to the individual office of your choosing

How to complete the referral form

1. Office location – check or circle location desired.
2. Patient information – Please complete all patient information. This information is necessary to expedite your referral and avoid return calls to your office.
3. Type of evaluation – check either Physician Consult or Procedure Only. If this is an urgent request, please check the urgent box. Referrals originating from an Emergency Room should be noted in this section of the referral form.
4. Physician Preference - check the box indicating any available physician or select a particular physician by office location. Should your patient have an identified cardiology problem requiring a specific sub-specialty request, please use our sub-specialty directory to find an appropriate sub-specialist. This section does not need to be completed for procedure requests.
5. Procedure Request – Check the appropriate test, taking care to provide additional information, i.e. height and weight, when noted. Our staff will provide pre-procedure instructions to scheduled patients. This section does not need to be completed for physician consult requests.
6. Indication for testing – Please note this section is mandatory.

Referral Form