Request a Referral

Thank you for your interest in UFE treatment at John C. Lincoln. Please complete the referral form below. As quickly as possible, we will provide you with contact information of John C. Lincoln UFE specialists in your area.

* Denotes required information.

Name *
Email *
If you would like us to follow up with you by phone.
Contact Preference *
ZIP Code
So that we can recommend a physician nearest you.
Additional information, such as symptoms or preferred physician location, that will help us recommend a specialist for you.

John C. Lincoln Physician Referral Service Disclaimer: Physicians in the Physician Referral Service sponsored by John C. Lincoln Health Network ('Lincoln') must be a member of the medical staff at one or both of Lincoln's hospitals to participate. If a physician ceases to be a member of the medical staff of at least one of Lincoln's hospitals, the physician will be removed from the Physician Referral Service database. There is no cost or fee charged to qualified physicians to participate in the Physician Referral Service. Participation by each physician is voluntary. We will refer you to a physician based on the specialty and location you request. Lincoln is not responsible for the medical services you receive from any physician to whom you are referred.

John C. Lincoln Health Network does not share personal information collected with third parties for marketing purposes.

Last updated October 2012.