Start your kidney care referral
For patients and families
You can start a referral now, for yourself or for someone you help take care of. You do not need a doctor's office to send it in for you. Fill in what you know and our staff will follow up with the rest.
- Who can send one
- Patients, family members and caregivers. You are welcome to fill this in on someone else's behalf if they have asked you to.
- About insurance
- Some insurance plans may require a physician referral before a specialist visit. Send yours in either way and we will check your plan with you.
- What happens next
- Our staff will call you back to help coordinate what happens next, including scheduling and anything your plan asks for.
Referral form
The form below opens inside this page. If it does not load on your network or your phone, call (731) 300-6155and we will take the same details down for you.
Some instructions about faxing records are written for doctors' offices. If a required question is unclear or you do not have the information, call us and our staff will help you complete the referral.
Sending this is not an appointment until our team confirms it, and it is not a place for medical advice. If you think this is an emergency, call 911 or go to the nearest emergency department.
Sending this from a doctor's office?
The clinician page has the records checklist, the fax number and the urgent referral line, along with the same form.