New Patient Referrals — West Michigan Cardiology

Referral Information

Referrals accepted via fax or electronically

Please fax most recent:

Labs
Patient records
EKG
Cardiac testing

616.454.5371 (Grand Rapids / Big Rapids)

616.754.9152 (Greenville / Lakeview)

Patient Name

First Name

Last Name

Date of birth

Patient phone

(###)

###

####

Patient Insurance Information

Provide insurance carrier / authorization number (if applicable)

Reason for referral

Location

Urgency

Referring Provider

Referring Provider Phone

(###)

###

####