Physician Referral Request Form
Request a referral to a physician practicing at Ascension Sacred Heart
ATTENTION: If you are experiencing a medical emergency, please dial 9-1-1 on your telephone. This online referral services is not intended for emergency situations and is only intended for residents of Northwest Florida and South Alabama.
Thank you for allowing us to help you find a physician for your health care needs. Our staff of nurses and referral specialists is available from 8 a.m. to 5 p.m., Monday through Friday to assist you in finding a physician who best meets your needs. All of the physicians participating in this service have admitting privileges at Sacred Heart Hospital.
Please call 850-416-4650 for this free service, or complete the form below and submit it to us by pressing the "Submit" button at the end of the page. Be sure to provide all the information so that we may contact you easily and find the appropriate physician.
If you do want a call back, please indicate your phone number and the best time for us to call. We also can send information to you in the mail or by email.
*If you are under 13, you may not send any information to us without your parents' permission. Filling out the following form does not set up or guarantee an appointment with a doctor. You will need to contact this doctor to set up an appointment if you wish to see them. You will be contacted with information regarding a physician that best suits your needs. If you are trying to make an appointment with your existing Sacred Heart doctor, please contact your doctor's office directly. The Sacred Heart Call Center is unable to make appointments for you.