Patient: Patients in need of an EMG must have a referral from their primary care physician. The EMGflint Referral form must be completed by patients’ referring and/or primary care physician and faxed to 810-732-4344. The completed referral will be returned to the patient and must be brought to the appointment. Your referring and/or primary care physician will advise patient of appointment date and time. Please print the form below and have your referring and/or primary care physician complete. The office will need to fax completed form to EMGflint at 810-732-4344.

Referring Physician: Please complete form and fax to 810-732-4344. The office will respond with appointment date and time.