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The Jackson Clinic

For Referring Providers

Home » Specialties » Dermatology & Mohs Surgery » For Referring Providers

For referrals, please call 731-664-8140.

We will need the following information: 

  • Patient’s full name
  • Date of Birth
  • Social Security Number
  • Phone number
  • Insurance Information
  • Reason for referral 

If referring for Mohs Surgery, please ensure the following are faxed to us:  

  • Patient’s pathology report(s) 
  • Photo of the biopsied lesion or graphical representation if your practice uses paper charts 
  • Referring provider’s name and contact information

Patient’s medical records and referral documents may be securely faxed to 731-660-8319.

We also request the referring provider’s name and contact information in your fax so that we may keep you informed of your patient’s treatment with us.