Physicians and Referrals

Thank you for referring your patients to McQuaid MD. 

Caring for your patient is a privilege that we take very seriously.  We will regularly share information and let you know how your patient is doing under Dr. McQuaid's care.  If you need additional information, please do not hesitate to contact our office. 

Mission Statement 
“McQuaid MD is committed to serving our patients by providing surgical evaluation and treatment of venous and surgical problems through a compassionate and caring approach. Our goal is to optimize our patients’ health by the use of proven and technologically advanced methods to correct surgical problems, medically manage nutrition and accomplish weight loss. McQuaid MD uses advanced, non-invasive testing to inform and educate, so that our patients can take immediate responsibility in improving their health. In order to optimize the benefit of data gathered from testing, we will communicate our progress with the patients’ referring physicians.”

Please fill out, at the least, your office contact information, the patient contact information and the reason for referral.

Referring Physician First Name:
Referring Physician Last Name:
Office Name:
Location:
Specialty:
Phone:
If your office has not referred to us previously, please add the following information about your office (Thank you):
Address:
Suite:
Bldg:
City:
Street:
Zip:
Phone:
Backline:
Fax:
Email:
Clinical Contact:
NPI:
Patient Demographic:
Patient First Name:
Patient Last Name:
Patient Date of Birth:
Patient Phone Number:
Address:
Suite:
City:
Street:
Zip:
Insurance:
Subscriber ID:
Group #:
Po Box:
800 #:
Reason for Referral:	Consult only Edema Follow up General Surgery Lab Other Other Procedure Phlebitis r/o DVT Varicose Veins-Venous Insufficiency
Patient Clinical History:
Appointment Requested: The patient is expecting your call.	YesNo
If your office is not the patient's primary care provider, fill out as much info as you have:
Phone:
Primary care physician:
Name:
Address:
Suite:
Bldg:
City:
Street:
Zip:
Phone:
Backline:
Fax:
Clinical Contact:
NPI: