Referral for Direct Schedule Screening Colonoscopy with Dr. Yamini Maddala

Please enter requested date for Screening Colonoscopy

In order to facilitate your patient in a timely manner please email or fax the following information:

  1. This Direct Schedule Screening Colonoscopy Form
  2. Current medical records along with recent labs
  3. Patient demographic/Insurance info/Referral Sheet

If you have questions about uploading into the Leading Reach/FibroBlast Referral platform, please call our office at (469) 697-5100.

Did you know that you can download the PDF form and email the information to [email protected] or Fax to (469) 697-5105

Thank you for entrusting Dr Maddala with your patient’s health care needs and supporting us in the prevention of colorectal cancer!