Refer a Patient - Referral Form

Thank you for your interest in having your patient treated at Gamma Knife of Spokane. We respect your sincere interest in providing the very best care possible for your patient and will do everything in our power to be an extension of that care you provide.

Fill out the information below and let us know via email if there is something more we need to provide for your patient.

Please complete all required fields (marked with an asterisk *). We need to collect this information to be able to contact you and best serve you. We do not provide this information to anyone else, period - your information is securely held by Gamma Knife of Spokane.

* I am a:	Physician Patient
* Neurosurgeon:	John Demakas, MD Alex MacKay, MD No Preference

* Patient Name:
Patient Date of Birth:	Example: 3/14/1960
* Patient Phone:
Patient Email:

* Referring Physician:
* Physician Phone:
Physician Email:
Physician Address #1:
Physician Address #2:
* Physician City:
* Physician State:
Physician Zipcode:
* How would you like us to report back to the referring doctor?	Email Snail mail

Special Information or Comment:
Human Verification:

The content of this web site is for _*informational purposes only*_ and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider. If you have a medical problem or a health-related question, consult your physician or call our center at 509.473.3800 for an appointment to meet with one of our neurosurgeons.