Refer a Patient

A streamlined referral process for physicians and healthcare providers.

Dr. Panossian welcomes referrals from neurologists, otolaryngologists, neurosurgeons, pediatricians, oncologists, and other specialists. Whether your patient requires facial reanimation, neurofibromatosis reconstruction, craniofacial surgery, rhinoplasty, or aesthetic procedures — we provide timely consultations and ongoing communication throughout the patient's care.

Virtual consultations are available for out-of-area patients to streamline the referral process. Our team will contact your patient directly to coordinate scheduling.

Referring Physician

First name

Last name

Specialty

Practice / Institution

Phone

Fax (optional)

Preferred contact method

Patient Information

Patient first name

Patient last name

Date of birth

Gender

Patient phone

Patient email

Insurance provider (if applicable)

Patient location (city, state)

Clinical Information

Reason for referral

Diagnosis / condition detail

Approximate onset or diagnosis date

Prior treatments or surgeries

Urgency

Imaging or records available?

Additional clinical notes

Relevant Photos

Upload up to 4 clinical photos if available. Click a box to browse or take a picture.

Photo 1

Photo 1

Photo 2

Photo 3

Photo 4

I confirm that the patient has been informed of this referral and consents to being contacted by Dr. Panossian's office to schedule a consultation.

Please check the box above to continue.

Our team will contact the patient directly to coordinate scheduling. You will receive confirmation of the consultation appointment and a post-consultation summary for your records.

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