Refer a Patient

Please fill out the new patient referral form and supporting documentation.

Please fill out the new patient referral form and get it back to us.

To refer a patient to our clinic, we require the following before scheduling an appointment:

1. Chromosome karyotype
2. Most recent well-child visit note
3. Demographic information (insurance, name, DOB, address, contact number, guardian name)
4. NICU discharge summaries (for children less than 1, if available)
5. Any other pertinent health information (if available)

Please fax the documents to 404-778-8562.

Once you have faxed the referral, please have the parents call 404-778-8570 to register their child with our clinic.

 To refer a patient to our clinic, we require the following before scheduling an appointment: 

• Fragile X genetic testing report
• Demographic information (name, DOB, address, insurance, contact info, guardian name)
• Most recent well child visit note
• Specialty visit notes (autism evaluations, Psychiatry, Neurology etc)

Refer a Patient 

• Fax medical records, insurance information, demographics, and referral information to 404-778-
  8562 to “Attention: Lysosomal Storage Disease Center Scheduling”
• Call the Emory Lysosomal Storage Disease Center at 404-778-8565 or 800-200-1524 to discuss scheduling your appointment.