for UNC Physicians Network


For UNC-PN Providers ONLY

Physicians within the UNC physicians network please use the forms below for referral to our office. Please fill out the Referral form and fax to our office at 919-362-5409 (Attn: New Patient Coordinator) 

Please have your patient sign the release so we can access the records in EPIC and fax to us with your referral. 

We are NOT able to process your referral with out these 2 documents and failure to send them will delay the appointment. 

UNC-PN referral forms

UNC Physicians Network Packet consists of a Referral to be filled out by the referring physician, and a Release of Information so we can access the patients chart in Epic. Please click the link below to download the forms. 


UNC Physicians Network Packet