Consultations & Referrals

Understanding we are one of many referral sources for your practice, we are streamlining our new patient process.

All new patient appointments must be made from a physician referral.
Please complete and submit the Referral Request Form below. This will be sent directly to our New Patient Coordinator to be processed.
Once our New Patient Coordinator has scheduled the appointment, she will call you. If you have not heard back from her within five business days, please contact us at 610-374-8133, option 5.

Records should be submitted to us via the Health Information Exchange. Our Direct address is: gregory.emkey.p1@direct.emkeyarthritis.nextgenshare.com

If the referring physician feels this is an urgent referral, please have him/her contact us directly at 610-374-8133.

Thank you for your trust in us to care for your patient!
The Team at Emkey Arthritis & Osteoporosis Clinic

Medical Referral Form

PATIENT DEMOGRAPHICS

Patient Name(Required)

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City ZIP / Postal Code

Gender

Marital Status

Email(Required)

Home Phone

Mobile Phone

Work Phone

INSURANCE INFORMATION

Insurance Company(Required)

ID(Required)

Group(Required)

Subscriber Name(Required)

Date of Birth(Required)

PROVIDER INFORMATION

Referring Provider Name(Required)

NPI(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Fax(Required)

PCP (if different then ref provider)

REASON FOR REFERRAL

Diagnosis(Required)

Attached Documents

Office Notes

Medical History

Current Medication List

Consults notes

Labs

Imaging Reports

Upload Attachments Here

Drop files here or

Max. file size: 50 MB, Max. files: 10.