Physician Referrals

This page is designed for physicians to refer their patients to OSNC physicians for consultation.

If you need to have your patient seen in an expedited manner and cannot call our referral coordinator, please download the Referral Pad, complete and submit to our office with the patient for review.

Click Here for Referral Pad (Downloaded in Adobe Reader File -- .pdf)

Or you may complete the form below:

Items in bold must be completed to submit physican referral.
Physician: Mark W. Galland, M.D.,
Orthopaedic Surgery & Sports Medicine
Clifford R. Wheeless, III, M.D.,
Orthopaedic Surgery
Paul B. Suh, M.D.,
Surgical & Nonoperative
Treatment of the Spine
Lawrence J. Yenni, M.D.,
Orthopaedic Surgery
Cary Idler, M.D.,
Surgical & Nonoperative
Treatment of the Spine
Ingrid Luo-Tseng, M.D.,
Physical Medicine & Rehabilitation,
Pain Management
Derek Watson, M.D.,
Physical Medicine & Rehabilitation,
Pain Management
Patient Full Name:
Diagnosis:
Notes/
Mechanism of Injury:
Patient Email Address:
Patient Daytime Phone:
Patient Evening Phone:
Patient Address:
Preferred Appt. Day:
Preferred Appt. Time:
Preferred Appt. Location:
Insurance Provider:
Carolina Access Number:
(if applicable)
Referring Provider:
Provider NPI Number:
Provider Phone Number:
Provider Fax Number:

Additional Materials are Available for Review

Check All That Apply:
X-Rays EMG MRI
U/S CT Labs
Bone Density
Other Information Not Listed


Please provide and instruct the patient to bring all relavant xrays, CT's, MRI's, and/or other relavent tests

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