Refer a patient

To initiate the referral process, download and fax the completed appropriate patient referral form and the release of information form to the Hume-Lee Transplant Clinics using the instructions provided on the form.

  1. Kidney transplant referral form
  2. Liver transplant referral form
  3. Release of information form

In order to facilitate the patient scheduling process, please also fax the patient’s demographics, updated labs, diagnostic images, clinical notes, and complete insurance information when submitting the referral. Once all information has been received, the patient will be contacted by our clinic to schedule an appointment.

If you have any questions or concerns regarding the referral process or a patient you have referred to Hume-Lee, please contact one of our Intake Coordinators:

Kidney Transplant Intake Coordinator:
Angele Lacks
(804) 628-0709

Liver Transplant Intake Coordinator:
Katie Mardigian
(804) 628-5334