Patient Referral Forms 

Referring Physicians

To refer a patient to Minimally Invasive Surgical Solutions, you have a couple of options:

• Call our office directly at (408) 918-0405 to schedule an appointment
• Fax our referral form to (408) 918-0409

Feel free to reach out to any of our physicians or practitioners if you'd like to discuss patient care concerns before your patient's visit or procedure.

 Patient Referral Form
 Diagnostic Imaging 
 Cardiology l Vascular
 Nephrology l Vascular
 Oncology
 Podiatry l Vascular

Health Plans Accepted 

 Health Plans Accepted

Conditions & Procedures

 Surgical Procedures

Refer Patients 

Clinic & Surgery Appointments: (408) 918-0405

Patient Referral Fax: (408) 918-0409


Benefits of Treatment here at MISS:

• Safe, with high standards of care
• No incision, minimal pain, and no scarring
• No general anesthesia required
• Outpatient procedure with same-day discharge
• Fast recovery, typically around two hours
• Cost-effective