Common Contracts
1 similar Patient Referral Waiver Agreement contracts
PATIENT REFERRAL WAIVER AGREEMENTPatient Referral Waiver Agreement • July 1st, 2016
Because Dr. Hogle is a specialist, some insurance policies require an authorization for your Primary Care Physician (PCP) to refer you. If your insurance policy requires authorized referrals, we need an authorization number and have a copy of the referral form mailed or faxed to this office prior to your appointment(s). If we do not have a copy of the referral form or you did not bring a copy with you, the following options are available:
