MOHS FAX REFERRAL REQUEST
Fax this form to make a referral for MOHS SURGERY
NOTE: All information is needed to schedule an appointment
Following MOHS surgery, your patient will be directed to return to your office for routine dermatologic care.
Thank you for referring your patient to our office.
Your message will be encrypted and can only be read by BOSWELL DERMATOLOGY.
Jared Lund, MD, FAAD, FACMS
Fellowship-trained Mohs Surgeon through the American College of Mohs Surgery
Your browser does not support capabilities required for electronic signatures.
Click a signature you want to use:
Copyright © 1999-2019 Hush Communications Canada Inc.