Dear Colleague,

Thank you for considering Cerbo Clinic for a neurosurgery referral.

Please fax a complete referral package to (650) 257-2979 so that we can schedule your patient without delay. 

If you prefer mailing the referral package, please send it to:

Cerbo Clinic Neurosurgery

Outpatient Scheduling

555 Bryant Street, Ste 909

Palo Alto, CA 94301

 

REQUIRED INFORMATION

• Physician office info (so that we can send the referral confirmation and consultation reports)
  • Name of referring Physician/Provider
  • Name of Clinic or Office (if different from provider)
  • Name of patient coordinator/scheduler/staff
  • Clinic/office phone number
  • Clinic/office fax number
  • Clinic email or scheduler/staff email, so that we can send the referral confirmation.
• Patient Demographics
  • Patient first and last name
  • Sex assigned at birth
  • Patient date of birth (DOB)
  • Phone number (mobile # preferred if available)
  • Valid E-mail address
• Patient Insurance information
  • Primary Ins Company information
    • Insurance company name
    • Insurance company address
    • Insured person’s name if different from patient
    • Patient/member insurance ID number
  • Secondary Insurance information
    • Insurance company name
    • Insurance company address
    • Insured person’s name if different from patient
    • Patient/member insurance ID number
  • Pre-authorization confirmation, if required if required for specialist consultation
• Diagnosis or reason for neurosurgery consultation
• Copy of the most recent visit note, including exam findings supporting need for neurosurgery referral
• Patient history including medical, surgical, family, and social history
• Medications and allergies
• ICD-10 codes related to the referral request
• Imaging reports (MRI, CT scans)

 

Reach out anytime for any questions or clarification about services we offer.

We appreciate the opportunity to care for your patients.

Dr Singel and team