Referral Form

Physicians Referral Form aaaasf-final.png

Submit Online Form Below

  1. Please include the most recent History and Physical or Office Note (ideally less than 30 days old).
  2. Please include most recent lab results. For most patients this includes BUN, Cr, eGFR, CBC, and INR.
  3. Please include any relevant imaging studies. NEEC has access to images at Baystate, Mercy, and Cooley Dickinson Hospitals. If images are only available on a disc, the patient should bring these in so that they may be loaded onto our PACS system.
  4. NEEC strives to provide the best communication possible. Please indicate your preferred method of contact for any patient related issues. Dr. Kahn may be reached directly on his mobile phone at (413) 429-6668 or via his personal email,


Patient Information

Referral Information

Please enter the number displayed in the box.