Refer a Patient

Patient Referral Request

Thank you for choosing Memorial Physician Group (MPG) as your healthcare partner. We look forward to providing comprehensive and quality care while focusing on healing the body, mind and spirit.

Please Note: Our team will confirm the appointment directly with your patient, and provide your office with confirmation and scheduled appointment updates.

To initiate a patient appointment, choose one of the following methods:

  1. Online: Fill in the fields of the online form below. Once complete, click on "Send Referral".
  2. Form: Download and complete the referral form, scan and/or email the completed referral form to
  3. Call: Call Memorial Physician Group Referral Line at 844-954-4674. Be prepared to provide the information asked on the form. Calls are answered 24 hours a day, however, you may be referred to a physician's office that has different office hours. Our physician offices will respond to your call within 24 business hours.

See all Memorial-employed physicians.

For a complete list of our medical staff, see our Physician Directory.

Refer an international patient.

Patient Information

Referring Physician Information

Medical Information

Daughter learning how to assist her mother during a Family In Training (FIT) Program session at Memorial Regional South.

Patient and Family Centered Care

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