Patient Referral Form for Physicians and Medical Professionals

To refer a patient to Surgical Associates, please download and complete the information requested. Any information you provide will enable us to assist your patient as efficiently as possible. Fax the completed form to (256) 355-6646 .

If you need immediate assistance, please contact our office at (256) 355-6414.

If you are a patient requesting an appointment for yourself, please contact our office directly.

Download our Physician’s Patient Referral Form