Refer a patient

Urgent referrals are reviewed within 4 business hours and routine ones within 2 business days. You'll see every status change in the portal and get the consult summary back automatically.

My referrals →

1. Patient

Patient name *

Date of birth *

2. Reason for referral *

Non-healing woundDiabetic foot ulcerPAD / CLTI evaluationHBOT evaluationVenous leg ulcerOsteomyelitisPost-amputation woundRadiation tissue injury

3. Urgency

RoutineSeen within 14 daysUrgentSeen within 72 hours: rest pain, tissue loss, stalled DFUEmergentAcute limb ischemia, sepsis, wet gangrene

4. Clinical details

Wound location

Wound duration (weeks)

Wagner grade (if DFU)

Signs of infection (erythema, purulence, warmth)

ABI: left

ABI: right

Notes / relevant history

5. Attachments

Add wound photos, notes, vascular studiesPDF or images

Referring as: Dr. Demo Referrer · NPI 0000000000

When to refer for PAD / CLTI

ABI < 0.90, or > 1.40 / non-compressible (check TBI)
Walking pain (claudication) that limits daily life
Pain at rest, tissue loss or gangrene: refer urgently
A diabetic foot ulcer with weak or absent pedal pulses

Common HBOT indications

Diabetic foot ulcer, Wagner grade 3 or higher, not improving after 30 days of standard care
Delayed radiation injury (soft tissue or bone)
Chronic refractory osteomyelitis
Compromised skin grafts or flaps
Crush injury, necrotizing soft-tissue infection (acute: call us)

Coverage criteria vary by payer. We verify and handle prior authorization.

Prefer to call or fax?

Referral line (555) 010-2400
Fax (555) 010-2401

Northbridge Wound & Vascular Center

Healing wounds. Restoring circulation. Saving limbs.

Phone: (555) 010-2400
Referral fax: (555) 010-2401

Main Campus

1200 Example Avenue, Suite 300
Springfield, ST 00000
Mon–Fri 7:30am–5:30pm

East Clinic

45 Sample Road
Springfield, ST 00000
Mon–Thu 8:00am–4:30pm

Quick links

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Refer a patient
Referral portal
Our team
Staff workspace

In an emergency, call 911. Information on this site is for education and does not replace advice from your doctor.