Provider Resources

Referrals

We've made it easy for you to submit your patient referrals! Use our form below, or send it via fax to one of the numbers listed below.

Southaven Referrals via Fax

(662) 349-9810

Germantown Referrals via Fax

(901) 614-8937

Referral Form

Use this form to submit your referrals. Please note, the form fields are for your information as a provider in case we have any questions. We'll get any patient information needed from the referral paperwork.