Physician Referral - Orthopedic Specialists of Louisiana

(318) 543-BONE (2663)

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Physician Referral

Thank you so much for your confidence in Orthopedic specialists of Louisiana. All of us at OSL are dedicated to providing your patients with the best in orthopedic health. We believe in a strong level of communication with our amazing healthcare colleagues and look forward to serving you and your patients.

Please refer using one of the following methods

Contact_phone 2

Dedicated referral phone line

You can refer a patient by calling our dedicated referral phone line
(318)629.5435

fax

Dedicated Appointment Fax

Download and fax this form to our dedicated appointment desk fax line
(318)629-5163

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Referral Request online

oslintake@msil.md

Use Online Referral Form

Physician Patient Referral

Referring Physician Name(Required)

Phone(Required)

Office Contact Name(Required)

Email(Required)

Enter Email Confirm Email

Referral Type(Required)

Patient Consult

Radiology (CT, MRI, X-Ray)

Patient Name(Required)

First Last

Patient Date of Birth(Required)

MM slash DD slash YYYY

Patient Cell Phone(Required)

Alternate Phone

Reason for Referral(Required)

Insurance(Required)

BCBS

Medicare

Other

Workers Comp

You selected "Other" for Insurance; Please specify.(Required)

You selected "Worker's Comp" for Insurance; Please specify Employer.(Required)

Does the patient have

Current X-Ray report

Current MRI Report

Please make sure the patient brings them with them to their appointment.

OSL Providers(Required)

Please Choose

First Available

Michael T. Acurio, MD

Steven M. Atchison, MD

Ellis O’Neal Cooper III, MD

Stephen L. Cox, MD

J. David Googe, MD

J. Marshall Haynie, MD

Val H. Irion, MD

Chase M. Lobrano, MD

Andrew G. Patton. MD

Jeffrey M. Pearson, MD

Please attach or fax (318)629.5163 all patient demographics, insurance information, radiology reports and last office visit notes to expedite referral.

Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, doc, docx, Max. file size: 16 MB.

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