Patient Referrals To submit a referral online, have your doctor fill the form below and submit it. For a printed form click the button below and tell your doctor to fax it to the Athens Heart Center Insurance Department at 706-208-8511 Referral Form To refer a patient, please fill out the following form. Patient Name*Patient Phone Number:*Date of BirthReason for ReferralPatient seeing which doctorPCP Name and #PCP email Physician or Office PhoneDiagnosisInsurance Policy and #Referral #Your NPI#Dr. Agrawal's NPI # is 1366443640Good for # Visits*12345+Comments This iframe contains the logic required to handle AJAX powered Gravity Forms. Home Make an Appointment Patients Cardiology Sleep Medicine Primary Care Preventative Services Physicians Patient Referrals Healthcare Industry Contact About Us Patient Resources FAQ Medical Records Patient Assistance Program Billing Full Time and Part Time Positions Notice of Privacy Practices Disclaimer Non-Discrimination Policy News