Baylor Medicine Spine Center Referral Form
If you have questions or need to discuss a complex or unusual case prior to submitting a referral, we can facilitate communication between you and one of our specialists. Call (713) 798-2225 or email firstname.lastname@example.org to contact a member of our staff.
To refer a patient, you have two options:
Complete the printable form and send it via fax or secure email with a copy of insurance card (front and back), HMO authorization if required, and relevant medical records and notes. If medical imaging (DICOM) and corresponding reports are available, please send using our ImageShare platform. Instructions can be found below.
Complete the digital form below. You can upload relevant medical records and notes, patient insurance information and HMO authorization (if required) with your submission. If medical imaging (DICOM) and corresponding image reports are available, please choose YES for the last question and provide an email where the invitation should be sent. We will send a follow-up email with instructions on how to easily share these files.
Have patient medical images?
Quickly and easily upload medical imaging (DICOM) and corresponding medical reports (if available) via our ImageShare.
If you are referring a patient using our digital form, we will send you a follow-up email with information on how to upload the patient’s imaging.