Date of Pre-Op:
Date of Surgery:

Thank you for the opportunity to take part in the care of your patient. Your referral has been processed. Your patient has been called and a pre–operative appointment has been scheduled. In anticipation of their surgical needs, we have tentatively scheduled their operative date as listed above. After the pre-operative appointment, we will send a confirmation letter of their operative date with information regarding post-operative appointment care. Please do not hesitate to contact our office if you have any questions regarding the surgical treatment of your patient. We look forward to working with you in co–management of their care.


Referral Coordinator

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655 Medical Center Dr NE       |       Salem, Oregon 97301       |     503.581.5287       |         Fax 503.386.1377       |