Gainesville Family Physicians, P.A.
Referral/Authorization Request

PLEASE READ THE FOLLOWING IMPORTANT INFORMATION

To ensure a prompt response, complete all requested
information. This form is used exclusively for referral/authorization requests.

As with any internet service, we cannot guarantee the confidentiality of your e-mail when using the form below. Please do not send confidential or sensitive material; try using our Referral/Authorization Fax Request instead.

It is not usually possible to receive your referral/authorization the same day. As with all referral/authorization requests at GFP, please inform us three (3) working days in advance.

It is the responsibility of you or your specialist to obtain the referral/authorization number prior to your visit.

Check with your insurance company to obtain your referral/authorization number. E-mail will be retrieved and responded to Monday - Friday from 8:30 to 4:30 pm.