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Referring a Patient

University Surgical Associates (USA) is pleased to offer its regional referring physician offices the ability to schedule patient appointments via fax or e-mail.

To fax a patient appointment, download the patient appointment request form and fax to (423) 778-5177. USA's online appointment portal will allow you to e-mail patient appointment requests through a secure and encrypted network, ensuring the information you submit is confidential.

To e-mail your request, please fill out the patient appointment request form online and submit by following the instructions provided. If you encounter problems downloading the form, you may need to download a newer version of Adobe Reader. You can download the latest version by clicking on the Adobe Reader link.

Once USA has received your request, you will be notified by fax or telephone regarding the status of your request. If you should encounter any problems please contact USA at (423) 267-0466.

Download Patient Appointment Request Form (All locations except Dayton)

Download DAYTON OFFICE Patient Appointment Request Form (Dayton location only)

Download VASCULAR ACCESS Referral Form (for vascular access patients only)