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Provider Referral Form

Duke University

University of North Carolina

Emory University

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HEALTH CARE PROVIDERS:

To refer a patient to the Cancer Genetics Network please print and complete the referral form in Acrobat PDF or Microsoft Word format and fax it to the Carolina Georgia Center institution of your choice:

Duke University
1-919-681-4766

University of North Carolina at Chapel Hill
1-919-843-7240

Emory University
1-404-778-4477

If you have questions about patient eligibility please contact one of the Carolina Georgia Center Program Managers:

  • Sydnee Steadman, MPA
    Program Manager
    Cancer Prevention, Detection, and Control Research Program
    Duke University Medical Center
    1-866-681-4762
    sydnee.steadman@mc.duke.edu

  • Lisa Susswein, MS
    Program Manager
    Lineberger Comprehensive Cancer Center
    The University of North Carolina at Chapel Hill
    1-877-692-6960
    susswein@med.unc.edu


  • Angela Everett, MPH, CHES
    Program Manager
    Winship Cancer Institute
    Emory University
    1-888-946-7447
    angela_everett@emoryhealthcare.org