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EmergeOrtho Triad Region Referral Forms

Thank you for choosing EmergeOrtho for the subspecialty orthopedic care of your patients. This page is designed to best serve referring providers and referral coordinators when referring a patient to EmergeOrtho Triad Region.

To submit a patient referral to one of our physicians, please choose one of the following options.

Option 1: Patient Referral by Fax

Complete & Fax our Patient Referral Form – Triad Region, attaching patient demographic information and office notes. One of our appointment representatives will contact the patient directly to schedule their appointment.

Option 2: Patient Referral by Phone

Call our Appointments department at 336-545-5001 – to speak with our one of appointment representatives.

Option 3: Online Patient Referral

To get started, select the Orthopedic Referral Form below. Then, complete the required fields, upload records, and submit your referral. If you need assistance, please call our appointment line at 336-545-5001 or email us at Referrals.Triad@EmergeOrtho.com

Thank you for your referrals.

EmergeOrtho Triad Region Secure Online Referral Form

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