Physician Referrals for: Hepatology Clinic • Elastography Imaging

The Texas Liver Institute providers offer treatment and evaluation for patients presenting across the spectrum of liver disease. 

Patients are seen by physician referrals. If the patient’s insurance is an HMO, we will need the name and phone number of the patient’s primary care provider and an authorization number for the clinic visit. The patient will be notified directly by phone/mail with the appointment date and time as well as directions.

To refer a patient or to arrange a clinic consultation, please 1) submit the online Patient Referral Form with supportive information or 2) download the Patient Referral Form and email the referral form and supportive information to or fax to (210) 237-4807.

Good communications between the Texas Liver Institute and your patients is central to providing excellent care. We will make every effort to provide you with the information you need to implement any recommendations we provide to your patient.

Reason for Referral


Patient InformatIon


Referring Provider Information


Medical Information


Please include the following information



Physician Referral Form

For a printable version of the form, please download the form below.

Download Referral Form Submit Physician Referral Form