Referrals

Patient's Name:

Phone Number: (just numbers)

Date of Birth: (mm/dd/yyyy)

DX(diagnosis):

Procedure:

Place of Service:

Date of Service: (mm/dd/yyyy)

MD referred to:

MD Phone #:(just numbers)

MD Fax #:(just numbers)

Insurance:
If other, please list:

Comments:

Office Hours

Monday 8:00am - 8:00pm
Tuesday 8:00am - 8:00pm
Wednesday 8:00am - 8:00pm
Thursday 8:00am - 4:30pm
Friday 8:00am - 4:30pm
Saturday 8:00am - 4:30pm
Sunday Closed

Contact Us

Ohio Valley Medical
Office Building
27 Heckel Road, Suite 107
McKees Rocks, PA 15136
Directions

Phone:
(412) 331-6503

Fax:
(412) 331-6804

E-mail:
mail@sauerandleibensperger.com
Please do not email office with urgent medical problems. Email is only to be used for non-urgent issues.


Patient Portal Instructions.