Click this Link for the Referral Form

To refer a patient to any physician at Emerald Coast Neurology please do one of the following:

• Complete referral using Order Facilitator
• Download and complete our New Patient Referral Form that can be faxed to (850) 438-3740

It is our goal to make the referral process as efficient and timely as possible. In order to achieve this we ask you to include:

• All possible documentation regarding patient’s condition
• Any radiology reports
• Recent office notes
• Copy of authorization or authorization number
• Copy of insurance card and driver’s license

Our new patient coordinator team can be contacted directly at : 850-438-1136 opt #1

We look forward to providing your patient with the best quality of care.