Physician Referrals

Physician Referrals

Dr. Mantas welcomes physician referrals from all doctors who are in need of expert gastrointestinal services. His facilities including clinic office, out-patient endoscopy centers and hospital gastrointestinal labs are state of the art and he and his staff are prepared to handle the full spectrum of gastrointestinal disease with the utmost care and compassion.

Dr. Mantas strives to schedule your patients as soon as possible and maintain a daily appointment slot for urgent cases. Following their appointment patients are given private access to the Digestive Wellness Center providing them with a wealth of knowledge on their gastrointestinal disease.

Dr. Mantas works very closely with all his referring doctors and keeps all involved health care providers apprised of their patient’s clinic visit, endoscopy and pathology reports and overall progress with same day detailed reports faxed to their office.

Dr. Mantas is deeply appreciative of your referral and honored to be given the trust in taking care of your patient. If you are physician or referral coordinator and would like to refer one of your patients to Dr. Mantas please download our referral form and fax to (214/972) 617-2000 or fill out the online referral request below and click send. In addition please fax over all pertinent office notes, prior procedure reports with pathology, imaging reports and labs to our office at (214/972) 617-2000.

- Download PDF Referral Form

OR

Complete The Electronic Form Below

Patient Status

RoutineUrgent

Referring Physician's Name

Physician's Phone Number

Physician's Fax Number

Physician's Email Address

Patient's Name

Patient's DOB

Patient's Address

City

State

ZIP

Patient's Phone Number

Patient's Insurance Information

Referral Reason

Colon Cancer ScreeningGERDOthers

Brief History & Physical

Security Question