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University Physicians of Brooklyn, Inc. (UPB)

Referral Forms

For the convenience of our referring physicians, the following referral forms may be downloaded as PDF's.

Please print the appropriate form, fill out completely, include physician's signature, and fax back to the number indicated on the form.


Sleep Disorders Center - Adults & Children

Man with oxygen mask on

Endoscopic Procedures

2 surgeons in O.R.

Radiology

Man looking at MRI film

Cardiology - Coming Soon

Man with EEG stickers on his chest

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