Referral Checklist

By referring patients requiring wound care services to our team, we can work collaboratively to enhance their recovery process.

Once you have identified a potential patient appropriate for consult/evaluation and treatment, you must submit the following documentations.

You can submit referrals through our secure online referral form, email, or fax.

Email: info@westcoastwound.com
Fax: (818) 856-9535

We only need a few pieces of required documentation to start processing a referral.

1. Face sheet/Patient’s demographics (Required)
2. Signed physician/PA/NP order (Required)
3. Insurance information (Required)
4. Include any family members who should be contacted for appointment scheduling (Optional)
   
   *Surgical wounds created in the last 90 days must have an order from the surgeon approving West Coast Wound to evaluate and treat due to a 90-day global period.