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To be considered a patient, our clinic requires a physical referral, along with a copy of the requested pertinent medical records demonstrating symptoms of autonomic impairment, and a completed clinical patient questionnaire.

For the clinical patient questionnaire, please click here

For the physician referral packet, please click here.

Please return the questionnaire and referral packet to:

Outpatient Clinic Office Assistant
Autonomic Dysfunction Group
Vanderbilt Heart & Vascular Institute
1215 21st Avenue South
Nashville, TN 37232
Phone: 615-322-2318    Fax: 615-936-8208
Phone: 800-288-5000, ext. 22318

Once we received these items, our team will carefully review your records to determine whether we are able to meet your medical needs within our specialized clinical practice.