Refer a Patient for Wound Care | Clovis Community Medical Center

If you’re a physician who’d like to refer a patient to the Center for Wound Healing at Clovis Community Medical Center please fill out the form on this page.

If emailing, please keep in mind this is not a secure form of communication, so consider calling if you have private information you'd prefer to keep confidential. We will not respond to solicitations.

Remember: we cannot provide diagnoses or medical recommendations. We are only here for educational and informational purposes. If this is an emergency, please call 9-1-1.

Referring physician:
Referring physician's phone:	( ) - First three digits Second three digits Last four digits
Referring physician's email address:
Address:
City:
State:
Zip code:
Please indicate which report(s) you'd like to receive (patient referral only).:	Progress Report Admission Report Discharge Report Discharge Summary Treatment Plan Additional Information
Please Specify Additional Information:

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