Refer a Patient — Tallahassee Neurology Associates

How would you like to send this referral?

Choose whatever is easiest for your office — all methods land in the same inbox.

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Fill the Form

Structured fields, fastest processing. Works great on phone or desktop.

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Upload Documents

Already have a referral PDF or printed form? Just upload it.

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Request Direct Messaging

Epic, Athena, or any Direct-capable EMR. We'll set it up for your office.

Your Information

Your office details for our team to contact you.

Your Name *

Practice / Hospital *

NPI Number

Your Phone *

Your Fax

Your Email (for confirmation)

Patient Information

Submitted securely — stored only on our servers, never shared with third parties.

Patient First Name *

Patient Last Name *

Date of Birth *

Sex

Patient Phone

Insurance

Insurance ID / Member #

Clinical Information

Reason for Referral *

Diagnosis / Clinical History

Primary ICD-10

Requested Provider

Current Medications (relevant)

Urgency *

Preferred Appointment Timeframe

Post-Visit Communication

We send a consultation note to the referring provider after each visit. How would you like to receive it?

Preferred Delivery Method

Send Notes For

Attach Records (optional)

Labs, imaging, office notes — PDF, JPG, or TIFF. Up to 5 files, 25 MB each.

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Click to browse or drag and drop files here

PDF, JPG, PNG, TIFF accepted

Upload Your Referral Documents

Upload your existing referral form, patient records, or any supporting documents. Our team will extract the information and contact you to confirm.

Your Name *

Practice *

Phone *

Email (for confirmation)

Urgency

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Click to browse or drag files here

PDF, JPG, PNG, TIFF — up to 5 files

Our team will review your documents and extract patient information. We'll call your office to confirm details before scheduling.

Request Direct Messaging Setup

We'll configure your office as a trusted Direct Message partner so referrals flow directly from your EMR to ours — no forms, no fax.

🔗 Direct Messaging Integration

Provide your office details and we'll reach out within one business day to complete setup. Compatible with Epic, Athena, eClinicalWorks, and any Direct Protocol-capable EMR.

Your Name *

Practice *

Your EMR / Direct Address (if known)

Phone *

Email *

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Referral Received

REF-XXXXXX

Your referral has been securely submitted to Tallahassee Neurology Associates. Our team will contact your office and the patient within one business day.

Practice: (850) 942-7177
Address: 2868 Mahan Drive, Suite 5, Tallahassee, FL 32308
Hours: Monday–Thursday, 8:00 AM – 4:30 PM
Fax: If you need to send additional records, reference your confirmation number on the fax cover sheet.

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Refer a Patient to Neurology

🔗 Direct Messaging Integration

Referral Received