Physicians Referral Form

  • To refer a patient to a KCNMG physician or provider clinics, please complete the information requested below. This is a secure form, and the information you provide will enable us to assist your patient as efficiently as possible.

    • Fax to 661.869.1834, Other Fax numbers can be found online at www.kernneuro.com.
    • Or just simply use the SUBMIT/SEND button to send it to us directly.
    • Include brief pertinent medical records, including test results that support the consultation.
    • Include patients insurance card (both sides) and HMO authorization if required.
  • Referring Physician Office Information:

    A KCNMG Referral representative will call the patient/contact person between 8:30am–5:00pm, Monday–Friday
  • Patient's Information:

    A KCNMG Referral representative will call the patient/contact person between 8:30am–5:00pm, Monday–Friday
  • Insurance:

    A KCNMG Referral representative will call the patient/contact person between 8:30am–5:00pm, Monday–Friday
  • Include patient’s insurance card (both sides) and HMO authorization if required.
  • o Faxed Medical Records and Insurance to 661.869.1834
    o Emailed Medical Records and Insurance to kcnmg@kernneuro.com
  • This field is for validation purposes and should be left unchanged.
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Patients and their physicians choose our neurologists because of their expertise in leading-edge diagnostic studies (EMG and NCV, EEG, Carotid Scan).

Introducing of pediatric neurologist Dr. Yawen Wang, MD

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