Requesting Information from Our Office
If you need to request a referral form, an EMG report, or contact from our staff please click here. Please include your name, the office and physician that is requesting the order form or report, your contact and fax information, and explain exactly what you're looking for. Include the name and date of birth of the patient if requesting an EMG report.
Please fax the referral to our office at 502-708-1339. Ask the patient to call our office and leave a message to get into our scheduling queue as soon as they're ready schedule. The referral must contain the following information. (PLEASE NOTE: Excluding any of the following information will likely cause a delay in scheduling your patient until we receive the requested info):
Patient full name
Patient date of birth
Test requested (EMG, NCV, or both) indicating the area to be tested (left/right/bilateral, upper/lower extremities, or specific part of the body, such as the face)
Appropriate diagnosis - some symptoms/conditions are not appropriate for EMG/NCV studies, please see our Do I need an EMG? section for more information. Additionally, a referal that indicates a primary diagnosis of Left CTS should not request a Right Lower Extremity EMG/NCV study
Referring physician's full name
Patient's address and working phone number
Current insurance information including Member ID and/or copy of insurance cards
If the appointment is related to a work or auto accident/incident we will need all of the claim information and the contact information for the case manager/adjuster, as the test(s) must be authorized before we can schedule the appointment
Fax number for where the report is to be sent after the test has been performed
Contact person and phone number for the referring office
Any relevant recent office notes
Previous EMG report, if available
Return appointment date if applicable
It is important to note we cannot schedule patients with cardiac pacemaker or implanted defibrillators, it is helpful to confirm this information with your patient before sending a referral as it will only delay their care by sending them to our office.
We are typically scheduled approximately 2-3 months out, so if you want to reschedule your patient in your office for after the test, we suggest you do so around this time frame or call our office and ask how far out we are scheduling.
If you have an ASAP patient or someone who needs a sooner appointment, it is important to notify our office so we can properly prioritize their appointment.
What To Do if Your Patient Hasn't Heard From Our Office
If we have already received the referral, we will typically contact the patient within 3 business days of receiving their call. If your patient hasn't heard from us by the beginning of the 4th business day please call our office to make sure we received the referral. Sometimes faxes aren't properly transmitted, we find that this is the most common reason for patients not receiving a call back.
Make sure that if the visit is to be through workman's compensation that we have all of the necessary information to get approval for the EMG, NCV and/or Consultation. We suggest the referring office attempt to get approval for the visit to our office as it usually cuts the wait time in half since adjusters often ask for information from the referring office that we do not have access to. The back and forth only delays the appointment being scheduled, as we need approval before we can even call the patient.
Scheduling Update: Effective May 5th, 2021
The safety of our patients and staff is paramount, therefore necessary safety protocols put in place due to COVID-19 have forced our office to substantially decrease our daily appointment slots. We are still not at fully capacity, so it is important to prioritize referrals based upon urgency. When faxing or emailing orders please indicate which patients are considered priority for medical management and we will provide a priority appointment. For non-urgent patients we regret that we may not be able to give appointments at this time or there may be a several week wait. If you have any questions you may call the office or send us an email through our Contact page. Check back on this webpage for future updates.
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