For Appointments
(205) 620-9065

Toll Free: (866) 622-0119

Physicians Corner

Referral Form to Request a Consultation for One of Your Patients

If you are a referring physician and want to send us a request for a surgical consultation, you may use the form below to send us the pertinent information. We will contact the patient within 48 hours of our receipt of the requested information. If you are looking for an appointment soon than this, please contact our office at 205-620-9065.

We will contact the patient directly to schedule, and fax back their appointment date and time for your records.

You may fill in this form directly on-line, and print, then fax, or complete it by hand and fax, to 205-664-5510.

Referral FormReferral Form

Release of Information Form

If you need records furnished on one of our patients and they have not seen us recently (in over one year), or have not established with your office yet, you may provide them the following form to request that we release their records to your office by faxing us a signed form to 205-664-5510.

Medical Records Release FormMedical Records Release Form

Transfer of Care to Richard Stahl, MD, at the University of Alabama at Birmingham

Those patient’s of Dr. Richard Stahl who wish to continue to following him locally in Birmingham may submit the following form and we will facilitate the transfer of care, by faxing a completed form to 205-664-5510.

Authorization Release of Medical Information to UAB for StahlAuthorization Release of Medical Information to UAB for Stahl

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Nondiscrimination Statement:

Cahaba Valley Surgical Group, P.C. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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