Referrals - About Us - Holzer Clinic

Referrals

Referral forms for our Lawrence County and Mason County facilities and the Health and Rehabilitation Center in South Charleston are now available. The forms are available in Microsoft Word and Adobe Acrobat format. Please choose from the List below.

Instructions After downloading the appropriate form, you can e-mail a copy of the form for Lawrence County. You will need to e-mail both Nathan Miller (nmiller@holzerclinic.com) and Charlotte Harbor (charbor@holzerclinic.com). Referral forms for the Orthopedic Center of Point Pleasant, Holzer Clinic of West Virginia, Health and Rehabilitation Center should be faxed to the appropriate number. You can also fax the Lawrence County referral forms using the appropriate number below. You may also call (740) 886-9403 for more details or instructions for the Lawrence County forms.

Available Referrals:

Holzer Clinic of Lawrence County
Allergy Christopher Clark, MD Phone: (740) 886-9403 Fax: (740) 886-3038 MS Word and Adobe	Gastroenterology (GI) Mark A. Subik, MD Phone: (740) 886-9403 Fax: (740) 886-3038 MS Word and Adobe
General Surgery Alice Dachowski, MD Phone: (740) 886-9403 Fax: (740) 886-3038 MS Word and Adobe	Orthopedics Wayne Amendt, MD Phone: (740) 886-9403 Fax: (740) 886-3038 MS Word and Adobe
Physical Medicine & Rehabilitation Glen P.Imlay, MD Phone: (740) 886-9403 Fax: (740) 886-3038 MS Word and Adobe EMG ONLY forms: MS Word and Adobe	Podiatry Jeffrey E. Shook, DPM, PLLC Phone: (740) 886-3003 Fax: (740) 886-3025 MS Word and Adobe
Rheumatology Mehmoodur Rasheed, MD Phone: (740) 886-9403 Fax: (740) 886-3038 MS Word and Adobe

Mason County Facilities
Holzer Clinic of West Virginia Dr. Lois Bosley, Dr. Michael Zirille, or Dr. Murray Willock Phone: 304-675-4498 Fax: 304-675-6569 MS Word and Adobe

Health and Rehabilitation Center (South Charleston)
Phyical Medicine and Rehabilitation EMG Referral Dr. Babayev or Dr. Chandra Phone: 304-746-3700 Fax: 304-744-2602 MS Word and Adobe	Phyical Medicine and Rehabilitation Dr. Babayev or Dr. Chandra Phone: 304-746-3700 Fax: 304-744-2602 MS Word and Adobe

Sleep Lab
Sleep Evaluation Direct Referral History and Physical Form Phone: 866-28-SLEEP (75337) Fax: 740-446-1298 MS Word and Adobe

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