Patches Orlando • Provider Referral

Newborn Circumcision Referral Form

Refer newborn patients for circumcision at Patches Orlando. This page is designed for pediatricians, family medicine physicians, newborn hospitalists, OB teams, and other clinicians coordinating outpatient newborn circumcision care.

Surgeon

Dr. Pablo Gomez

Pediatric urology specialist providing newborn circumcision care through Patches Orlando.

Urology Kids

1350 S Orlando Ave

Winter Park, FL 32789

407-410-3949

For Referring Providers

Fast, Clear, Secure Intake

Submit demographics and clinical details through the secure referral form below.

HIPAA compliant
We will verify insurance/payment information and contact you back if needed
No separate follow up referral to the surgeon is needed.

Secure Referral Submission

Complete the referral form below to submit patient information for review.

HIPAA-conscious workflow

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Referral Form