The Clinical Neurosciences Center is here to assist community physicians and specialists with consultation and referral services. To refer a patient, please complete our online physician referral form and fax all related clinic notes and diagnostic reports to us. Once the form is completed, you will receive a return email confirming your referral and providing you with a referral tracking number in case you would like to follow-up or provide additional information at a later time.

The information submitted will be reviewed within 48 hours to ensure that the proper neurologist or neurosurgeon evaluates each case, and the patient will be contacted about an appointment.

Contact Us:
Phone: (801) 585-7575
Fax: (801) 585-2746
Fax for MEG referrals: (801) 585-2746
Fax for EMG referrals (801) 581-8859

Physician Information
Patient Information
Has the patient had any of the following?
Insurance Information Primary Insurance
Secondary Insurance

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