Refer a Patient

Thank you for entrusting OrthoSC with your patients' orthopedic care.

Please fill out the form below, and we will contact your patient directly within 24 hours to schedule an appointment. To speak with a scheduler, please call us at (843) 353-3460.

If you are a patient interested in making an appointment, please click here.

Referring Office Contact Information

Referring Physician

Your Name

Phone Number

Email Address

Fax Number (Optional)

If you would like a confirmation of your patient's appointment, please provide your fax number.

Patient Information

Patient Name

Date of Birth

Patient Phone Number

Patient Alternative Phone Number

Patient Email Address

Patient Insurance

Reason for Referral

Does this visit relate to a workers' compensation claim?

Yes

Patient Has Completed

Bone Scan

CT Scan

MRI

EMG

X-Rays

Cast/Splint Applied

CAPTCHA

Schedule an Appointment

Refer a Patient

Conway

Conway Physical Therapy & MRI

Murrells Inlet

Myrtle Beach – Carolina Forest

Myrtle Beach – Market Common

North Myrtle Beach