Physician Referral Fax Form Fax # 954.355.4881 - Broward Health - browardhealth-2026

1. Click ‘Get Form’ to open the Physician Referral Fax Form in the editor.
2. Begin by entering the date at the top of the form. This helps track when the referral was made.
3. In the 'Referring Doctor' section, fill in your name and any relevant credentials to ensure proper identification.
4. Next, provide the patient's information including their name, social security number, date of birth, phone number, and cell number. Accurate details are crucial for effective communication.
5. Fill in the insurance information to facilitate billing processes. Ensure that all details are correct to avoid delays.
6. Describe the patient's symptoms clearly in the designated section. This information is vital for assessment at Broward Health Heart Valve Center.
7. Check off any tests that have been performed and include results if available. This helps streamline patient evaluation.
8. Finally, indicate the total number of pages being faxed to ensure complete documentation is sent.

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