Send a Secure Referral

Flow Heart & Vascular

Send the referral you already have

Attach your referral order and available records. You do not need to retype clinical history already included in the attachments.

Urgent or STAT referral for a clinically stable patient? Call 480-571-1863 first to discuss triage. Do not wait for this form to be reviewed. For an emergency or unstable patient, arrange appropriate emergency care or call 911.

Patient’s full name

Patient’s date of birth

Patient’s phone number

Optional if the patient’s current contact information is in your attached referral.

Referring clinician and practice

Include your name if you are sending this on the clinician’s behalf.

Direct office callback number

Include an extension or direct line for referral questions.

Requested referral path Urgent/STAT referrals and physician discussions require a phone call to 480-571-1863.

Routine referral Urgent/STAT — clinically stable; call the office first Physician-to-physician discussion — call the office

Referral reason or clinical question

A brief reason is enough. If it is in the attached referral order, enter “See attached order.” Add any important timing, contact instructions, or original-image availability.

Referral order and supporting records Attach available notes, labs, test reports, medication list, and patient contact/insurance information. A combined PDF is helpful. Up to 20 files and 75 MB total per submission. For more files, send another submission using the same patient name and date of birth and label it Part 2. Call for large imaging studies.

Add file

Please upload a file

Prefer fax?

Fax your referral to 480-571-0269. You may use your own referral order or our referral form (PDF).

Please do not include Social Security numbers or payment-card details. Sending this form does not confirm an appointment or acceptance of a referral. Our office will review the information and coordinate next steps.

Questions or urgent triage: Call 480-571-1863.

Your information will be encrypted.