REFERRAL REQUESTS
Thank you for choosing HeartPlace!
In order to make the referral process as easy and convenient as possible, once we receive the referral form,
WE WILL:
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Contact the patient
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Make the appointment
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Inform your office of the date and time
Depending upon the service desired, our office may request pertinent medical records. Once the consultation and/or test are completed, you will receive a report detailing our findings and recommendations. If we can improve your experience with HeartPlace in any manner, please do not hesitate to call.
...And once again, thank you for choosing HeartPlace!
Telephone Referrals
Each office is staffed by scheduling personnel who will be happy to make appointment requests via telephone. Just call the appropriate office with:
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Patient's Name
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Contact Information
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Desired service to be performed (consultation, test).
You may find the telephone numbers below or by clicking the following link Find A Clinic.
Fax Referrals
Some of the HeartPlace offices offer a fax referral option. If you see the link below to the particular office you wish to refer, you may click on that link and download the Referral Form specific for that office.
Simply fill in the pertinent information and fax it back to our office. The fax numbers are on the forms.
You will also need the Adobe Reader to view and print these documents. Use the icon below to download Adobe.
FORMS BY CLINIC:
FORMS BY PROVIDER:
CLINIC PHONE NUMBERS:
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817-284-3915 - Alliance
PROVIDER NUMBERS: