Appointments and Referrals

UCSF Peripheral Nerve and Complex Limb Reconstruction Center
A Combined Service of the Departments of Orthopedic and Plastic Surgery
University of California, San Francisco
1500 Owens Street, 2nd Floor
San Francisco, CA 94158
Tel:  415-353-4947 (Appointments)
Fax: 415-353-9643
email: [email protected]

Please feel free to contact our practice coordinators, Lucas Lopez (415) 353-4947 or Theresa Nguyen at (415) 353-9392 should you need further assistance.  

For Referring Providers

For physicians seeking consultation or referrals, please contact us at  415-353-4947.
Please provide us with the following:  Peripheral Nerve Referral Checklist (pdf)
Please download this Referral Form, and fax your authorization to 415-353-9643.

  1. Referral from your physician
  2. Medical records including any pertinent notes regarding your symptoms and imaging reports
  3. All available MRI, CT, Ultrasound and X-Ray Imaging that has been done to date copied to a CD
  4. Results of any electrodiagnostic testing (NCS/EMG).
  5. Patient and insurance demographics (address, contact number and front and back copies of insurance cards)
  6. Insurance authorization. Please refer to our Peripheral Nerve Referral Checklist (pdf)
    When required, it is your responsibility to work with your referring physician to obtain prior authorization to your appointment. If your insurance does not require prior authorization please send a note with (call reference number, agent name, phone number, and message). If you have Medicare Part B, we do not need prior authorization.
  7. Please mail or fax to: 


    UCSF Peripheral Nerve and Complex Limb Reconstruction Center
    UCSF Orthopaedic Institute
    1500 Owens Street, 2nd Floor
    San Francisco, CA 94158
    tel:  415-353-4947
    fax: 415-353-9643

  8. Once all information is received, the referral is carefully reviewed by our team to determine the most appropriate evaluation. Our office will contact patient or family directly within 2-4 weeks for scheduling.

Patients Self-Referrals

Patients can self-refer through the UCSF’s Second Opinion portal (please specify Dr. Igor Immerman to review).  This is often preferred by those who:

  1. Seek a second opinion;
  2. Have not yet scheduled an appointment with a doctor regarding this condition.