For any referral that requires a prior authorization (North and South Carolina Medicaid, Tricare or any Private Insurance HMO) we would ask you to have the parents call our office directly to make their appointment at (704) 540-3667 after the faxed referral has been sent by your office.  We will not be calling these patients as we have found it too time consuming and inefficient as mobile phone numbers change so frequently.

Additionally we ask you to please include that the following information and make sure that it is updated and accurate prior to faxing any new referrals:

Name of patient and DOB
Parent/guardian’s name (and DOB)
Insurance information is current and active
That the referring provider listed on insurance card is correct (if applicable)
Referring provider’s group NPI number

Once this information is confirmed then please fax the referral to our office at (704) 540-3668 and notify the parent/guardian to call to schedule the appointment (704) 540-3667.

An appointment may be delayed if the above information is not accurate or if we have not received the faxed referral.

Please contact us directly for any urgent consults so that they might be expedited. Patients can download and print all new patient registration material from our website. 

We at Pediatric Urology Associates strive to provide the best possible service to our referring providers and the best possible care to your patients. We appreciate every one of your referrals and strive to do our best with each and every patient that you trust to our care. We will try to respond to each new patient referral in a timely manner and get the patient in as soon as possible. 


For urgent consults please call our office (704) 540-36687 so that we can arrange to work the patient in the same day. You will also be asked to fax the new patient intake form to our office as well so that we may enter the demographics. Fax (704) 540-3668.


For routine consults we ask you to merely fax the new patient intake form to our office at the above noted fax number. We will respond with a confirming fax as soon as the appointment has been made.


If there are any concerns or questions about this process please feel free to contact our office at (704) 540-3667 or ask to speak to one of the physicians.

Call Us:  (704) 540-3667

Pediatric Urology Associates, Charlotte, NC