By appointment only, often with no wait time.


Referral Request

Referrals are completed every week on Monday and Thursday mornings. Please use the form below to request a referral for an upcoming appointment - it will be completed on the following Monday or Thursday morning. Referrals will be faxed to the appropriate doctor's office and emailed to the patient. We highly recommend that you bring a copy of your referral to your upcoming appointment.

Please note, we can only make referrals for patients who list Dr. Edward Bennett as their primary doctor (PCP/PMD) with their insurance policy.

  • MM slash DD slash YYYY
  • The ID number is specific to each insurance provider. You should call the specialist that you plan to visit and ask their office staff for the number or you can call you insurance provider.
  • (ie neurologist, cardiologist, dermatologist)
  • MM slash DD slash YYYY
  • What is the complaint?
  • Please enter a number from 1 to 99.
  • *Please note that if you have not seen Dr. Edward Bennett within the last 3 months we will be unable to complete your referral request
  • *Also, It is the patients responsibility to change the PCP/PMD as per insurance guidelines