Referring Physicians

Referring physicians and referral coordinators, we thank you for trusting us with your patients. It is our pleasure to provide them with the most valuable care for their dermatologic needs, including Mohs surgery.

Please fill out the contact form below for inquiries to our Referral & Authorization Department. You can also send a Fax to 321-206-5419. We look forward to assisting you.

Referring Physicians Form

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Click here for a comprehensive list of our accepted insurance plans.

My encounter with all the staff made me feel welcome. They exemplified courtesy, professionalism and knowledge concerning my care.

— Shirley D.

Schedule Your Appointment Now

Fill out the form below to contact us.

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<form-template><fields><field required="true" type="text" name="first-name" placeholder="First Name*" label="First Name"/><field required="true" type="text" name="last-name" placeholder="Last Name*" label="Last Name"/><field required="true" type="text" name="phone-number" placeholder="Phone Number*" label="Phone Number"/><field required="true" type="text" name="email-address" placeholder="Email Address*" label="Email Address"/><field required="true" type="select" name="select-location" label="Select Location"><option value="">Select Location*</option><option value="Altamonte Springs">Altamonte Springs</option><option value="Apopka">Apopka</option><option value="Celebration">Celebration</option><option value="Clermont">Clermont</option><option value="Davenport">Davenport</option><option value="Dr. Phillips">Dr. Phillips</option><option value="East Orlando">East Orlando</option><option value="Hunters Creek">Hunters Creek</option><option value="Kissimmee">Kissimmee</option><option value="Mount Dora">Mount Dora</option><option value="Ocoee">Ocoee</option><option value="Poinciana">Poinciana</option><option value="St. Cloud">St. Cloud</option><option value="No Preference/Not Sure">No Preference/Not Sure</option></field><field type="select" name="area-of-interest" label="Select Area of Interest"><option selected="true" value="">Select Area of Interest</option><option value="Clinical Dermatology">Clinical Dermatology</option><option value="Cosmetic Dermatology">Cosmetic Dermatology</option></field><field type="select" name="existingpatient" label="Existing Patient?"><option selected="true" value="Established Patient">Established Patient</option><option value="New Patient">New Patient</option></field><field type="date" name="date" label="Appointment Date"/><field required="true" type="select" name="appointment-time" label="Appointment Time"><option selected="true" value="8:00-8:30">8:00-8:30</option><option value="8:30-9:00">8:30-9:00</option><option value="9:00-9:30">9:00-9:30</option><option value="9:30-10:00">9:30-10:00</option><option value="10:00-10:30">10:00-10:30</option><option value="10:30-11:00">10:30-11:00</option><option value="11:00-11:30">11:00-11:30</option><option value="11:30-12:00">11:30-12:00</option><option value="1:00-1:30">1:00-1:30</option><option value="1:30-2:00">1:30-2:00</option><option value="2:00-2:30">2:00-2:30</option><option value="2:30-3:00">2:30-3:00</option><option value="3:00-3:30">3:00-3:30</option><option value="3:30-4:00">3:30-4:00</option><option value="4:00-4:30">4:00-4:30</option><option value="4:30-5:00">4:30-5:00</option></field><field type="text" name="insurance2" placeholder="What is your Health Insurance?"/><field required="true" type="select" name="preferred-call-time" label="When is a good time to call?"><option selected="true" value="">When is a good time to call?*</option><option value="Morning">Morning</option><option value="Afternoon">Afternoon</option><option value="Evening">Evening</option></field><field type="textarea" name="comments" placeholder="Enter any comments or questions here..." label="Comments"/><field type="hidden" name="rendered-form" value="is_rendered"/></fields></form-template>

Upon submission, a representative will contact you during normal business hours to confirm your request.

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