Referring Physicians

The decision to refer a patient to Westside Head & Neck should be easy. We also want the referral process to be easy for you, your staff, and your patients. We offer a few options to submit referral forms:

To Refer a Patient

  • Print and fax: Print the Referral Form, fill out, and sign. Once you’re done, please fax the forms and required documentations to 310-204-4474.
  • Email: Download the Referral Form, fill out, and sign. Once you’re done, please email to, along with required documentations.
  • Fill out the forms online: Fill out and sign the form online. You can complete the Referral Form below and once you’re done, click ‘submit’ and it will automatically send to our team.

Our front office is your one-stop team for scheduling appointments.
Westside Head & Neck respects the relationships you have with your patients and is committed to open communication and prompt follow-up after your patient is seen. We recognize that your patient looks to you as his or her primary provider — and we expect to entrust your patient back to your ongoing care after being seen at our office.

We are an in-network provider for millions of people. To refer a patient, you don’t need to know a staff member at our office or have a previous relationship with us.

Why Refer Your Patient to Westside Head & Neck?

  • Quality.Our physicians are consistently up to date on new diagnosis and treatment techniques and refining and improving existing ones.
  • Locations. We have locations conveniently located in Los Angeles. With one location in the heart of downtown Culver City, and a second location in Santa Monica, our patients can be seen by our doctors with ease and convenience.
  • Ease.Fax, email, or fill out online—we offer several ways to refer patients, all streamlined to save time for you and your colleagues.
  • Expertise. Our expertise is found in few other medical offices, including novel treatment options and in-office services often done in a more expensive and less convenient hospital setting.
  • Collaboration. Working together with medical professionals in the community allows us to collaborate with you to provide the highest quality care to our patients.

Summary Notes

Our front office staff will collect your patient’s medical records once he or she is seen and ensure that you receive them in a timely manner via mail, fax or email. Our physicians will forward a summary of diagnostic reports and treatments to you as soon as it becomes available.

Fill Out Referral Request Online

If you would like to fill out the referral form online, you can do so by completing and attaching the necessary documents below. Once you click ‘submit,’ it will automatically send to our team:

1301 20th Street Suite 510
Santa Monica, CA 90404

3831 Hughes Avenue Suite 704
Culver City, CA 90232


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