REFERRALS AND CONSULTS
Below are forms that may be used by primary
care providers and other doctors office referral departments to refer
patients to Fort Mill Dermatology.
You may use your own forms as long
as they contain the same patient information. All three forms below
contain the same information. Choose the format that best
suits your needs. If you have any questions about these forms
or the referral process, please call Greg Smith at 803-802-3376
This PDF contains form fields that can be filled by typing on the form
or copying and pasting information from your practice management system.
The completed form
can be printed and then faxed and filed.
PDF - This is a standard form in PDF format for printing. It can then be
filled out and faxed.
WORD DOC -
This is a standard form in Word format. If you prefer Microsoft
Word format, use this form.
To provide the best possible coordination
of care for your patients, we promptly fax referring providers progress notes on
the same day that they are seen in our office. We appreciate your
referrals and thank you for allowing us to participate in the care of your