Request a Consultation

Take the first step. Complete the form below and our patient coordinator will contact you within one business day to confirm your appointment.

Consultation Request

Tell Us About Your Goals

First Name*

Last Name*

Email Address*

Phone Number

Procedure of Interest

Preferred Contact Method

Best Time to Reach You

How Did You Hear About Us?

Tell Us About Your Goals*

By submitting this form you consent to being contacted by our office regarding your consultation request. This form does not establish a physician-patient relationship. For medical emergencies, please call 911.

Prefer to Call?

Our patient coordinator is available during office hours to answer questions and schedule your consultation.

(601) 936-0936

Our Location

The Atelier Building
114 Market Street, Suite 200
Flowood, MS 39232

Get Directions

Office Hours

Monday8:00 AM – 4:00 PM
Tuesday8:00 AM – 4:00 PM
Wednesday8:00 AM – 4:00 PM
Thursday8:00 AM – 4:00 PM
Friday8:00 AM – 12:00 PM
SaturdayClosed
SundayClosed

Your privacy matters. All consultation requests are handled with strict confidentiality in accordance with HIPAA guidelines. Your information will never be shared or sold.

For Healthcare Professionals

Referring Providers

We welcome referrals from physicians, primary care providers, and other healthcare professionals. Our team is committed to seamless communication and timely follow-up on every patient you entrust to our care.

A Note of Gratitude

We are deeply grateful to the referring offices and providers who trust us with their patients. Your confidence in our team means everything to us, and we are committed to honoring that trust with exceptional care, clear communication, and timely follow-up. Thank you for being an essential part of our patients' journeys.

Send a Referral

Referrals may be submitted by phone, fax, or email. Please include the patient's name, date of birth, contact information, reason for referral, and any relevant clinical notes. Please note that a referral is not required — patients are welcome to contact us directly.

Request Records

To request operative reports, consultation notes, or other medical records for a shared patient, please contact our office directly. A signed patient authorization form will be required in accordance with HIPAA guidelines.

Call: (601) 936-0936
Email: [email protected]
Records requests processed within 5 business days

What to Expect

Once a referral is received, our patient coordinator will contact your patient within one business day to schedule a consultation. You will receive a consultation report following the appointment.

Patient contacted within 1 business day
Consultation report sent to referring provider
Ongoing communication throughout care
Prompt return referral when appropriate

Questions About a Referral?

Our referral coordinator is available Monday – Friday during office hours.

(601) 936-0936 Fax (601) 936-0938 [email protected]