Request a Physician Referral

Sidelines has complied a list of some of the best high-risk physicians across the United States. If you would like to find a Perinatologist or High-Risk Obstetrician near you, please fill out the following information, and we will contact you.

Physician Referral Form

Name
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Email
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Email (retype)
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Street Address
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City
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State
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Zip Code
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Country
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Phone number
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Please give the name of the largest city you are willing to travel to for treatment
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Are you currently pregnant?
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If so, what is the number of weeks along in current pregnancy?
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If you are currently pregnant, are you looking for a second opinion?
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Have you had a prior loss?
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What is your primary complication or concern?
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