Thank you for referring your patient to us. In addition to this online request please fax us at 919-908-6081 the following from:
Referral Form Updated August 2021 (PDF file).
All of the following are required to be faxed to Carolina Vascular Access for an Appointment to be made: Signed Order, Demographic Sheet, Medication List, Most Recent H&P, List of Allergies, Insurance Info.
Referral Form