Make an Appointment: 817-225-2716
Email: info@totallyvein.com

Provider Referral’s

If you are physician or physician’s office and you are referring a patient from your office to us, please provide us with the following information:

  • Physician’s name and office phone number
  • Office address
  • Patient’s name
  • Patient’s demographics including address, phone number, etc.
  • Reason for referral

** Please provide insurance information that the patient has so that we can verify the patient before their visit.**

Any tests or labs that have been completed for Dr. Siddiqui to have on file before he sees the patients.

Please fax over the information to (817) 225-2719.

Please call our friendly office staff at (817) 225-2716 if you have any questions or need further information to refer a patient.
** THANK YOU FOR YOUR KIND REFERRALS!!**