Specialist Referral Forms

QSMM is proud to offer specialist services to help the needs of your patients. Please fill out the form below and submit to the fax numbers listed on each form. We will respond right away and for urgent requests, please call us today!

INTERNAL MEDICINE – DR. PRABHPAL SANDHU

Dr. Prabhpal Sandhu is accepting referrals for Internal Medicine at Parkland and Glenwood Medical Clinic. Download the referral form below to get started:

Download Dr. Prabhpal Sandhu’s Referral Form

OBSTETRICIAN & GYNECOLOGIST – DR. ADEL ABDULHAFID

Obstetrician & Gynecologist Dr. Adel Abdulhafid is accepting referrals at our Women’s Health Clinic at Parkland Medical Clinic. Download the referral form below to get started:

Download Dr. Adel Abdulhafid’s Referral Form

OBSTETRICIAN & GYNECOLOGIST – DR. TAHER AL-JISHI

Obstetrician & Gynecologist Dr. Taher Al-Jishi is accepting referrals at our Women’s Health Clinic at Glenwood Medical Clinic. Download the referral form below to get started:

Download Dr. Taher Al-Jishi’s Referral Form

PEDIATRIC CARDIOLOGIST – DR. IAN ADATIA

Dr. Ian Adatia is accepting referrals for consultation services in Pediatric Echocardiography at Glenwood Medical Clinic. Download the referral form below to get started:

Download Dr. Ian Adatia’s Referral Form

PEDIATRIC/NEONATOLOGIST – DR. PAT MATEO-RODRIGUEZ

Dr. Pat Mateo-Rodriguez is accepting referrals for General Pediatrics at Granville Medical Clinic. Download the referral form below to get started:

Download Dr. Pat Mateo-Rodriguez’s Referral Form

SLEEP DISORDER REFERRAL FORM – QUALITY SLEEP CARE

Quality Sleep Care is accepting referrals for sleep disorders. Download the referral form below to get started:

Download Quality Sleep Care Referral Form