We are here to serve the physicians who entrust their patients to our specialized care.
In order to serve you in the most expedient and efficient manner, please download the following form to send to our office.
You may fax the completed form and supporting documents to: 912-800-6560
OR Email to: Drsoffice@summitcancercare.com
It is very important that all information requested on the form is included to facilitate prompt scheduling of your patient.
As noted on the form, following is the information to include with your fax or email:
Patient’s full name, date of birth and contact information
Patient’s insurance information to include a clear copy of the front and back of insurance card(s)
Reason/diagnosis for referral
Results of pertinent lab tests, imaging or pathology
Locations are staffed as follows:
Savannah and Statesboro – Drs. Chahin, Goldberg, Lewis, Robertson, and White
Savannah and Springfield – Drs. Luskey, Spellman, and Taylor
Pembroke – Drs. Chahin, Goldberg, Lewis, Robertson, and White
**For Savannah, Statesboro, and Pembroke locations, please contact 912-354-6187 for any questions regarding New Patients or New Patient Referrals.
**For the Effingham / Springfield location, please contact 912-754-2560 for any questions regarding New Patients or New Patient Referrals.