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Easy Access to EmergeOrtho Orthopedic Referral Forms (by Region)

EmergeOrtho makes the referral process as seamless as possible by enabling referring physician offices to upload patient records when submitting web referrals. To get started, simply find the location you are looking for, click the link at the bottom of the page, select the orthopedic referral form you need, and upload records and orders.

Each EmergeOrtho region has its own orthopedic referral form, MRI/CT referral form, pain management referral form, physical & occupational therapy referral form, and more.

To access a physician’s referral form, please choose a region. Or, request a visit now for subspecialty orthopedic care, North Carolina patients choose.

Blue Ridge Region Foothills Region Triad Region Triangle Region Wilmington Region

Referring Physicians

At EmergeOrtho, we are honored to partner with you on orthopedic and spine referrals. To speak with a member of our referral center, please call:

Provider Hotline: (910) 332-1500

EmergeOrtho’s Physician Liaison is Susan Kirkendol. Please contact Susan if you need assistance with referrals, have questions or concerns. You may reach Susan by phone/text at 910-523-1690 or email at [email protected] 

We appreciate the trust and your referral of your patient to EmergeOrtho- Wilmington Region. Your feedback is very important to us. Please let us know how we are doing by completing this brief referring provider survey.

EmergeOrtho Referring Provider Survey

The following referrals are available in this region:

Diagnostic Imaging Access

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