Thank you for your referral. Below is an outline of steps in making a referral to us.

1. Please download forms, complete and give to your patient at the time your office schedules appointment with us. Instruct the patient to bring these with them at their first appointment with us. If you prefer, you can send the completed forms directly to us by scanning and emailing forms to dawallace@usouthal.edu or dfletcher@usouthal.edu.

2. Please fax all patient records when you are scheduling the appointment. This ensures that your patient in scheduled in the appropriate clinic, which is based on medical history. Be sure to include: patient OB history and original labs. We will need more than the summary sheet and all ultrasounds so we can counsel your patient on complex information.

3. Please advise your patient that if they are late for their appt. by 30 minutes they will be rescheduled so we can be timely with all our patients.

Patient Information Form

Patient Responsibility Form

Patient Checklist

Obstetrics History Form