Request a Referral

Request a Referral

Referral requests are retrieved from this site several times daily. There is no need to submit multiple requests for the same referral. We do ask that you give us the courtesy of requesting your referral no less than 3 days prior to your specialist appointment. If you are an Aetna US Healthcare or Keystone Health Plan East member, there is no need to pick up your referral at Hatboro Medical. The information will be sent electronically and will be available to your specialist within 24 - 48 hours of your request.

Please fill in all information as completely as possible.
Then click the "Finished" button at the bottom of the page.

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Patient Information

* Last Name:

* First Name:

Middle Initial:

* Date of Birth:

* Social Security #:

* Phone:

Referral Information

* Referring Doctor:

* Specialist's Name:

* Specialty:

* Insurance Company:

* Insurance ID#:

Date of Referred visit:

* This this an(a):

Reason for Referral:

Hatboro Medical Associates
345 North York Road
Hatboro, PA 19040
(215) 675-1516

Email: info@HatboroMedical.com