To refer a patient to us, we ask that you provide our office with the following information:

• Or download the form by clicking here

• History and Physical

• Recent office notes

• Recent pertinent hospital records

• Recent labs

• Imaging – if the imaging was not performed at HMI , a disc can be mailed to our main office 6565 West Loop South, Suite 110, Bellaire, TX 77401.

• Patient’s insurance information including ID number, group number, provider or customer service phone number.

• Click here to view the insurances we accept. 

Questions can be directed to our office staff at 832-350-7260.

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Please complete the referral sheet below: