How to Refer a Patient

1. 1

   Complete the Referral Order Form

   Download and complete the SMIT Referral Order Form (PDF), or use the SMIT Referral Intake App to complete and submit the referral electronically.

2. 2

   Include Required Information

   Patient demographics, date of birth, insurance information, referring provider name and NPI, contact information, and clinical indication for referral.

3. 3

   Submit the Referral

   Fax completed forms to (903) 787-8825, or submit electronically via the SMIT Referral Intake App.

4. 4

   Patient Scheduling

   Our staff will contact the patient to schedule an appointment. Urgent referrals should be noted on the form or communicated by phone.

5. 5

   Receive Consultation Report

   You will receive a consultation report following the patient's evaluation at SMIT.

Referral Forms & Tools

SMIT Referral Intake App

The SMIT Referral Intake App allows referring providers to complete and manage referrals electronically. The app supports the following actions:

Supporting Documentation

When available, please include relevant supporting documentation with your referral:

• Prior sleep study results (if applicable)
• Relevant office notes or H&P
• Current medication list
• Insurance authorization (if required by the patient's plan)
• STOP-BANG or other screening tool results (if completed)

Pre-Referral OSA Screening

The AIO STOP-BANG tool is a validated, widely used questionnaire for identifying patients at risk for obstructive sleep apnea. It can be completed quickly in a clinical setting to support referral decisions.