Skip to main content
(205) 228-7600
Careers
Patient Portal
Online Bill Pay
Request an Appointment Online
Mobile main menu
About
Careers
News & Events
Notice of Non-Discrimination
Online Privacy Policy
Sports Affiliations
Doctors
Areas of Specialty
Back, Neck & Spine
Elbow
Foot & Ankle
Hand & Wrist
Hip
Interventional Pain Management
Joint Replacement & Revision
Knee
Orthopedic Trauma
Physical Medicine & Rehabilitation
Rheumatology
Shoulder
Sports Medicine
Locations
Birmingham
Hoover
Childersburg
Services
Bone Health & Osteoporosis Clinic
Diagnostic Imaging
Durable Medical Equipment (DME)
Electromyogram/Nerve Conduction Study
Pharmacy
Walk-In Clinic
Therapy
Search
Main menu
About
Doctors
Areas of Specialty
Locations
Services
Therapy
Search
Search form
Search
Search
Refer a Patient
Home
Appointments
Refer a Patient
Referring Office Contact Information
Referring Physician
Your Name
Phone Number
Email Address
Fax Number (Optional)
If you would like a confirmation of your patient's appointment, please provide your fax number.
Patient Information
Patient Name
Date of Birth
Patient Phone Number
Patient Alternative Phone Number
Patient Email Address
Patient Insurance
Symptoms & Diagnosis
Was this injury/condition related to workers' compensation?
Yes
No
Patient Has Completed
bone scan
CT Scan
MRI
EMG
X-Rays
Cast/Splint Applied
Requested Time to Be Seen
1-2 Days
3-5 Days
Submit
Appointments
Refer a Patient