FOR REFERRING PHYSICIANS | DIRECT ACCESS AND CONSULTATION FORMS

If you are a physician and wish to refer a patient for a colonoscopy/endoscopy or refer a new patient for a consultation, please use the convenient forms below. You may also call our office at 407-384-7388 or the direct referral can be downloaded, completed and faxed to us.

DIRECT ACCESS FOR COLONOSCOPY / ENDOSCOPY (FOR PHYSICIANS ONLY)

This form is for referring physicians and their staff only. Please note that if you are a patient, you must contact your referring physicians' office and they will complete this form. This form will be delivered via email to the staff at Digestive and Liver Center of Florida.

In addition to completing and submitting  this form, please fax a copy of the patient's H&P, medication list, and front and back of insurance card and demographic sheet to 407-506-0104.

Please attach a fax cover stating "Forms for direct access referral, attention William".

Submit the form and we'll contact you for more information. Thank you. Please use this form for non-urgent appointments only. For same-day or urgent appointments, please call our office at 407-384-7388

This form does not make an appointment, it is a request. Our office staff will follow up by phone to make the actual appointment.

Thank you for referring your patient to the Digestive and Liver Center of Florida . We look forward to serving you and your patient with high quality consultative, endoscopic and continuing gastroenterologic care.

We offer direct referral endoscopy for screening colonoscopies and other indications.

To make a referral you may call our office, complete the referral online and submit it, or fax a Direct Access Referral Form to us at 407-506-0104.

Thank you for the opportunity to serve you and your patients. Click here if you would like us to bring business cards to your office.