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Referring Doctor and Office Form to Set Up Appointment

If you are a patient needing an appointment, click here instead

REFER A PATIENT FOR EVALUATION FROM YOUR OFFICE

Please fill out the following form and fax over medical records to 214-774-9762.

Reason for Referral

Thanks for submitting!

Please call to confirm or with any questions - 214-774-9771

© 2014 by Advanced Heart and Rhythm, PLLC

3650 W. Wheatland Rd. Suite C, Dallas, TX 75237

Tel: 214-774-9771

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