Provider Referral
Thank You for Referring Your Patient to Jackson Siegelbaum Gastroenterology!
At Jackson Siegelbaum Gastroenterology, our highly-trained specialists are dedicated to patient-centric care. Our mission is to provide your patients with an exceptional experience, leading to the best possible outcomes. Your patient has placed their trust in you as you help to guide them, and we thank YOU for placing your trust in our team to further assist.
We have two easy ways for you to refer a patient to our practice:
Please note – Our providers schedules do fill up quickly, so we encourage you to send the records promptly so that we do not have any delay in scheduling your patient.
Send via Secure Fax
The records we typically request along with the Appointment Request Form are:
– Patient demographics sheet
– The last office note
– Any relevant labs & imaging results
– (Optional) Any other records you feel are pertinent to the appointment
Please fax the completed Appointment Request Form along with the appropriate medical records to 717-761-0465
Send via Secure Mail
If you would like to overnight the request along with the printed medical records, we ask that you do so through trackable delivery to ensure the documents arrive securely at our facility.
You may mail the form and records to:
Jackson Siegelbaum Gastroenterology
200 Grandview Av.,
Suite 101,
Camp Hill PA 17011