Referring Providers

We Welcome Your Referrals

Referring physicians across the region recognize the value of the specialized urology services offered at Minnesota Urology. That’s why so many of them refer their male and female patients to us for the highest level of care.

Online

After completing this online form, please attach a copy of any pertinent office notes, labs and/or imaging in the document upload section or fax to 651-999-6969.

Patients will be contacted by one of our schedulers during business hours Monday through Friday upon receipt of the request.

Patient Name*
Date of Birth*
Date Format: MM slash DD slash YYYY
Phone Number**
Email Address*
Does Patient Require An Intrepreter?
Select Language
Diagnosis And/Or Special Instructions
Referring Physician Name
Scheduler Name
Scheduler Email Address
If You Have A Preference Of Which Physician You’d Like To See, Please Select Their Name Below:
If You Prefer A Specific Location, Please Make Your Selection Below:
Document Upload

Drop files here or

Fax

Download Fax Form

Phone

Hotline to Schedulers: (651) 999-6811

Hotline to Physician Liaison/Physicians: (651) 999-7781

Find the service you need at a location near you.

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