Your browser does not support JavaScript!
This form cannot automatically check that you have submitted all of the required fields without JavaScript.
Please be sure to submit all required fields (marked with stars).

FastHealth Logo

Franklin Foundation Hospital Logo

Online Physician Referral

Need a Doctor? Physician Referral is a free community health service offered to community members in need of a physician. Callers can be matched with appropriate physicians for treatment and care. Our staff will even schedule your first appointment for you. Reminder calls and follow-up calls also help insure that your care is everything you expect from your hospital.
Please fill out all required fields to allow us to have all of your contact information.
* Full Name:
First Name, Middle Initial, Last Name
* Phone Number:
Area Code + 7-digit Phone Number
  Physician Needed:
Enter the physician you wish to see, if applicable.
  Email Address:
Please enter the email address you check most frequently.
  Date and Time:
Please tell us the best day and time to contact you.