Physician Referrals

Thank you for the opportunity to care for your patient’s dermatological needs.

Golden State Dermatology is led by a team of board-certified dermatologists, providers and staff committed to providing your patients with the best care.

Our Golden State Dermatology practices and affiliates provide general dermatology, cosmetic dermatology, Mohs skin cancer surgery, pathology and plastic surgery.

We treat all ages including pediatric patients and have on-site Mohs surgeons at most clinics.

Refer A Patient

Our commitment to patient care ensures patients are offered timely appointments. We have multiple locations to care for your patients, many offering same-day and next-day appointments.

We believe closing-the-loop for clinical referrals improves patient safety and satisfaction, as well as clinical care coordination. Our providers believe in prompt follow-up and fax chart notes to referring providers in a timely manner.

It’s now easier than ever to refer patients to Golden State Dermatology.

2 Ways to Refer a Patient to Golden State Dermatology

Fax: Send us your patient referral to the desired location. Click here for Fax numbers
OR
Online Referral: Complete the referral form below
We will call your patient to coordinate the referral.

Referral Form

"*" indicates required fields

Patient Information

Your Name*

Date of Birth*

Email*

Phone Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Preferred Location*

Referring Provider Information

Provider Name*

Practice Name*

Phone*

Email (Optional)

Fax*

Reason For Consultation*

Patient Preference*

How did you hear about us?*

Insurance Information

Insurance Company*

Policy Number*

Authorization Required?*

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