Physician Referral: Online Request Form 

Physician Referral Service: South Miami Heart Center

Baptist Health's Physician Referral Service is available Monday - Friday, 8 a.m. - 5:30 p.m. Phone calls and e-mails left after hours or on the weekends will be returned the next business morning. This physician referral service will put you in touch with a Baptist Health South Florida affiliated physician in Miami-Dade and Monroe counties only. This is a free service.

For help in finding a physician, simply fill out the online form below to request a referral. You may also call the Physician Referral Service at 786-596-6557. Outside Miami-Dade County, call toll-free, 800-228-6557.

By submitting this online request for a physician referral, you agree to the Terms and Conditions of Use and the website Privacy Policy. If you do not agree to these terms, you may call Baptist Health Physician Referral Service at 786-596-6557 to request a referral to a physician on the medical staff at a Baptist Health facility.


I agree to the  Terms For Online Physician Referral Service
   

Personal Information

First Name  

Last Name  

Patient's First Name  

Patient's Last Name  

Address 1

Address 2

City

State

Zip Code  

Country

Telephone  

Fax

Date of Birth (MM/dd/yyyy)    


E-mail  

Medical Information

If you need a Primary Care Provider, what type of physician do you prefer?


If you need a specialist, please specify the medical condition and/or the type of specialist you need:


If you are unsure of what type of specialist you need, please specify the symptoms for which you seek treatment:


Are there any other specific qualifications, such as languages spoken or office location, that you would prefer to see in this physician?


Insurance Information

Your primary insurance, including the complete name of the plan:


Contact Information

How would you like us to respond?  



Other Information

Have you previously used the Physician Referral Service at Baptist or South Miami Hospitals?  

Have you ever been a patient at Baptist, South Miami, Homestead or Mariners Hospitals?  

How did you hear about our website?


Thank you for using the online Physician Referral Service for South Miami Heart Center.