Patient Referrals

We would like to help physicians ensure their patients receive exceptional and prompt dermatology services. We promise to maintain clear communication in a way that is most convenient for you, and we will respect the relationship that you and your patient have established.

If you would like to refer your patient for dermatology services, please use the form below and we will follow up with you concerning their need.

Vanguard Referral

Provider Information

Patient Information


Request an Appointment

IMPORTANT: This form is not a secure exchange. Please refrain from sharing personal health information. If you need assistance with a medical issue or have a medication question, please call the office at (765) 446-0282 – our medical/triage voicemail is monitored closely!