Please use the following referral slip when sending your patient to our office. It may then be faxed to the office your patient desires or they may bring it with them to their appointment. Your confidence in Facial Surgery Group is greatly appreciated!
Please feel free to use the following method to refer your patient to our offices on-line.
- After clicking submit we will receive the referral and look forward to hearing from your patient to schedule an appointment.
- Please submit any x-rays or supporting documentation for our Plaza office to TonyaR@facialsurgerygroup.com or for our Barry Road location to Brenda@facialsurgerygroup.com.
- Our primary concern is the security and privacy of your patient's personal information and we would like to reinforce that we have taken all measures to protect it.