For Physicians

Refer a Patient

 

Please fill out and fax the following form to (850)640-0761. Once received, our staff will contact you and the patient to schedule a consult date and time. Please also include:

 

  • Office Note
  • Pathology Report
  • Scan Report
  • Patient Demographics 

 

REFERRAL FORM

 

Insurance Information

 

Prior to your patient’s initial appointment, we will collect insurance information, verify benefits and get financial authorization, helping them to receive full insurance coverage that is available under their plan. For uninsured patients, we will ask for an initial deposit based on the estimated cost of treatment. Actual charges may be higher or lower.

 

Second Opinion

 

A second opinion after a cancer diagnosis can be very helpful as they offer your patients reassurance and peace of mind by confirming that they are choosing the most appropriate treatment. At Hope Regional Cancer Center we offer same day second opinion consults with our team of medical oncology/hematology and radiation oncology physicians.

 

Clinical Trials

 

Hope Regional Cancer Center is part of a national exclusive group of centers where cancer patients are approved to enroll on Radiation Therapy Oncology Group (RTOG) protocols. Our collaboration through the RTOG brings us in communication with nationally recognized experts at major academic centers. Contact us to learn more about current clinical trials at Hope Regional Cancer Center.

To learn more about RTOG, click the following link: RTOG Home Page