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Physician Referral Service Application
Thank you for your interest in joining our free Physician Referral Service.

In order to be on our Physician Referral Service, you must fulfill the following requirements:

  • Be in an Active status as defined by Medical Affairs at one of our hospitals.
  • Have appointment availability to see patients in two weeks or less.
  • Provide updated insurance information every six months.

 

 

 

 

 

 

Physician Referral Application 

Complete the Application: Call Center Physician Referral Application
Note: You must have Adobe�s free Acrobat(r) Reader(r) software installed to fill out the Application electronically. You must have an active internet connection when submitting the application.

Get Adobe Reader - Get the Free Download!
Contact for Help: Tel: (727) 519-1509 | e-mail: Contact.CenterReg@baycare.org

Physician Referral Lines:

 
Tel: (727) 462-7500


Tel: (727) 825-1111


SJH Tel: (813) 870-4747
SFB Tel: (813) 754-4444
SJW Tel: (813) 872-2949

BayCare Contact Center
Physician Referral & Class Registration
Operating Hours: 8 a.m. ' 5 p.m. Monday thru Friday

16255 Bay Vista Drive | Clearwater, FL 33760-3127 | Telephone: (727) 519-1509 | Fax: (727) 519-1514

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