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 fax a face sheet along with office notes, labs and imaging to 833-905-0989.

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*
MM slash DD slash YYYY
Phone Number**
Email Address*
Does Patient Require An Intrepreter?
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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:
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Fax

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Phone

Hotline to Schedulers: (651) 999-6811

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

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