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EmergeOrtho Triad Region Referral Form

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: Secure 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 Referral Department at 336-545-5000 Option 2 or email us at [email protected]

Option 2: 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 3: Patient Referral by Phone

Contact our Referral Department at 336-545-5000 Option 2 – to speak with our one of representatives.

Option 4: Patient Referral via Proficient Health

As part of the Triad Health Network (THN), EmergeOrtho Triad Region accepts and manages patient referrals online from participating THN practices.

Thank you for your referrals.

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