Refer a Patient

Thank you for entrusting Sierra Pacific Orthopedics with your patients.

If you are a patient interested in making an appointment, please click here.

If you are with a physician practice referring a patient to Sierra Pacific Orthopedics, simply complete the only web form below, and we will contact your patient to schedule an appointment within 24 hours. If you'd prefer to print out a referral form and fax it to us, please click the "Additional Resources" button below, where you can find and print our referral sheet.

To speak with a scheduler, please call our office directly at (559) 256-5200, or for additional resources to refer a patient, please use the button below.

Additional Resources

Referring Office Contact Information

Referring Physician

Your Name

Phone Number

E-Mail Address

Fax Number (Optional)

If you would like a confirmation of your patient's appointment, please provide your fax number.

Patient Information

Patient Name

Patient Phone Number

Date of Birth

Patient Alternative Phone Number

Patient E-Mail Address

Patient Insurance

Requested Doctor

Symptoms & Diagnosis

Does this visit relate to a workers' compensation claim?

Yes

Patient Has Completed

Bone Scan

CT Scan

MRI

EMG

X-Rays

Cast/Splint Applied

File to Upload

One file only.
2 MB limit.
Allowed types: pdf, doc, docx, txt, jpg, jpeg, png.

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