• Click here to download a printable form, which may be completed, signed, and faxed back to us, or simply complete and submit the electronic form below. To arrange an appointment, please contact the access team via the number below.

    Urology Oncology:
    TEL: (205) 934-8051
    FAX: (205) 975-4235


    MAILING ADDRESS
    1720 2nd Avenue South FOT 1107
    Birmingham, AL 35294-3411
    Attn: Urology Oncology

    Please select a Urologist from this page and submit the required new patient information and imaging, along with this form to the fax number or address provided.

  • If none specified, your referral will be routed via our physician sub-specialty rotation list
  • ALL NEW PATIENT REFERRALS REQUIRE A COPY OF THE PATIENT'S INSURANCE CARD AND PHOTO ID.
  • MM slash DD slash YYYY
  • Fedex or UPS overnight methods are recommended for CDs of images or material that cannot be uploaded electronically. Please use shipping options with tracking when possible so that we can ensure timely service. Secured link can also be sent for immediate image transfer.

    Our physicians see patients at:

    The Kirklin Clinic of UAB Hospital, 2000 6th Avenue South- Urology 5th Floor, Birmingham, AL

    AL Medicaid, VA, Cooper Green, VIVA Medicare Plus, CIGNA, Champus Tricare, Humana Military, and Humana Gold Medicare require a letter of prior authorization before an appointment can be scheduled.

    UAB Urology is out of network for Secure Horizons, Health Springs, UHC and Medicare Complete insurance. A gap exception referral letter must be obtained by the referring physician before an appointment can be scheduled. Please fax all records to (205) 975-4235.