Physician Referral Form
Upload records or just the basics — a name, diagnosis, and phone number is enough to start.
How Referring Works
Two ways to connect your patients with enrolling clinical trials — send us the chart, or let us come to you. Either way, your patients stay under your care and nothing moves forward without your approval.
Option A · Fastest
Use the form on this page
- Share what you have — upload medical records and/or patient information. A recent note, med list, and labs are ideal, but not required.
- We pre-screen against every enrolling protocol and contact the patient directly.
Option B · Zero lift for your staff
We come to you — breakfast on us
- Pick a morning that works for your practice.
- We bring breakfast and sit down with your team — no prep needed.
- We help your staff search the EMR for patients who match enrolling trial criteria.
- You give final approval before anyone is contacted.
We screenOur coordinators confirm eligibility and walk the patient through consent — at no cost to them.
You stay informedYou receive updates at enrollment and major study milestones.
They stay your patientTrial participation runs alongside — never instead of — your care.
Curious what we’re enrolling right now?
See enrolling trials
All records and referrals are handled securely and in accordance with HIPAA.