Referrals During COVID-19
The Polyclinic is committed to helping you navigate the care of your patients during COVID-19.
Starting May 5, we will offer more services onsite. We will also begin to perform elective surgeries effective May 18, like joint replacements for those with chronic pain and limited mobility, as well as elective procedures such as colonoscopies for patients at risk for colon cancer.
We will continue providing video visits for new and established patients. For questions about a referral, or what type of visit may be best for your patient, please contact the clinic directly.
We appreciate your referrals and look forward to working together in the care of your patients.
With more than 35 specialties at The Polyclinic, we want to ensure you have the resources needed to refer your patient for care.
Refer a Patient
1. Determine specialty or service for referral. Visit our clinic directory. Contact sheets available for viewing and printing below (updated quarterly).
- Specialty Physicians and Services - Allergy-Orthopedics
- Specialty Physicians and Services - Otolaryngology-Vascular Surgery
- Pediatricians and Specialists Who Treat Pediatric Patients
- Primary Care Providers with Open Practices
2. Send the patient's chart notes and complete documentation directly to the clinic by phone or fax. If urgent, please call the clinic.
- By Phone – Call the specialty clinic directly. For emergencies, call 911.
- By Fax – Send complete referral to the specialty clinic directly. Please print clearly and include all demographic and clinical information needed, including insurance, and test or lab reports.
What is considered a complete referral?
Please include all clinical record information, including test or lab reports, patient demographic information, insurance information and reason for referral. Use our referral request or include all information in the faxed referral.
3. What to expect next – Appointments can be scheduled once the referral is processed. Please instruct your patient to call and make an appointment. We will contact you if there is any missing information from the referral.
Referral and Procedure Forms
For most referrals, you can call and fax directly to the specialty clinic office. Below are forms that could be needed depending on the referral.
- Referral Request for All Specialty Clinics
- Diagnostic Imaging Referral Form
- Laboratory Test Requisition Form
- LabCorp Requisition Form
- Reverse Sequence Syphilis Screening
For questions regarding the status of a patient referral, please contact the clinic directly. For general questions, email email@example.com.