Referral Form
Specialist Referral Process
Once you choose a specialist and have scheduled an appointment with them, you can request a referral by either calling: 508-477-5306 Ext #6, faxing the requests to: 508-477-0297, or you can email the request to: capecodreferral@gmail.com.
In order to process your referral accurately and timely the following information is required.
- Patient Name
- Patient Date of Birth
- Patient Telephone Number
- Specialist Name
- Specialist Telephone Number
- Specialist Fax Number
- Specialist NPI
- Date of Appointment
- Reason (diagnosis) for Appointment
If you do not have all of this information, please contact the specialist's office to obtain the needed information prior to submitting your request.
Thank you for your cooperation.
Cape Cod Pediatrics
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