Referral Form

We will see your patient within 24 hours. Guaranteed.

Please use this secure online form to refer a patient to one of AOC’s orthopaedic physicians. To refer a patient by phone, please call our Physician Referral Line at 251.410.3686. Or click to download a PDF version of our Referral Form to fill out and email to appointments@alortho.com or fax to 251.410.3868.

1. INJURY INFORMATION

Have x-rays and/or an MRI been taken for this condition? Yes No

*If yes, please have patient bring with them to the appointment.

2. PATIENT INFORMATION

Patient Name: Date of Birth:

Home Phone: Cell Phone:

Social Security #: Insurance:

3. APPOINTMENT INFORMATION

First Available

Please note that although physicians are listed below by specialty, all AOC physicians perform general orthopaedic services.

footankle
  • John C. McAndrew, III, MD
  • Grant M. Shell, MD
AOC-DeptLogos-FractureCare
  • Jason Rene Rocha, MD
  • John T. Riehl, MD

hand
  • Jared L. Burkett, MD
  • William A. Crotwell, III, MD
  • Suanne White-Spunner, MD
spinecare
  • D. Kevin Donahoe, MD
  • Tim S. Revels, MD

jointreplacement
  • Matt Barber, MD
  • Michael L. Granberry, MD
sports
  • Clayton G. Lane, MD
  • W. Christopher Patton, MD
  • Cesar M. Roca, Jr., MD

general
  • Roger M. Setzler, MD
  • Andre J. Fontana, MD
  • Russell A. Hudgens, MD

Preferred Appointment Day:
No Preference   Monday   Tuesday   Wednesday   Thursday   Friday

Preferred Appointment Time:No Preference    AM    PM

4. REFERRING PHYSICIAN INFORMATION

Referring Physician: Clinic:

Contact Person:

Phone Number: Fax Number:

We will call your patient to schedule their appointment. You will receive confirmation once their appointment has been scheduled. Please feel free to call our PHYSICIAN REFERRAL LINE (251.410.3807) with any questions you may have. Thank you for referring your patients to Alabama Orthopaedic Clinic, P.C.