Clinician Referral Form | The Kidney Experts

Referral process

Include enough information for our team to identify the patient, understand the kidney concern, and reach the right person for scheduling.

Complete the referral form with patient demographics, insurance information, contact details, and the clinical reason for referral.
Fax recent labs, including eGFR and creatinine when available, medication lists, and pertinent notes to 731-300-6955.
Our team reviews the referral promptly, contacts the patient or referring office when needed, and coordinates scheduling.
If the referral is urgent, call our referral line at 731-300-1191 after sending records.

What to include

Patient demographics and best contact number
Insurance information and referral authorization details, if needed
Recent labs, including eGFR and creatinine when available
Current medication list
Reason for referral and relevant clinical notes

Please send only what is neededDo not include unnecessary PHI beyond what is required for referral review and scheduling. For urgent referrals, call 731-300-1191 after sending records.

Referral form

The form below opens inside this page. If it does not load on your network, fax the referral to 731-300-6955 and call731-300-1191.

Passing this along to a patient?

Patients and caregivers can send the same referral themselves, written in plain language, with our staff handling insurance and scheduling from there.

Patient referral

Refer a patient to The Kidney Experts

Referral form

Passing this along to a patient?