Urgency Room - Tareen Dermatology

The Urgency Room Referrals

Thank you for entrusting Tareen Dermatology with your patients’ care. Our team is committed to providing timely, high-quality dermatologic services. Once this form is submitted, we will contact the patient within 24 hours or by the next business day. If you have additional notes or records to share, please fax them to us at (651) 331-3459.

Referring Provider's Name(Required)

First Last

Referring Provider's Email Address

(Optional for receiving notes)

Patient Name(Required)

Patient DOB(Required)

Patient Phone Number(Required)

Level of Urgency (Pick one)

(Optional)

Emergent (Seen within 24–48 hours) - e.g. suspected melanoma, rapidly growing lesion, infected or draining cyst

Urgent (Seen within 3–5 days) - e.g. worsening rash, painful or inflamed lesions, suspected skin cancer

Soon (Seen within 1–2 weeks) - e.g. persistent but stable skin conditions requiring evaluation (e.g., non-healing lesion, new rash)

Routine (Seen within 3–4 weeks) - e.g. acne, eczema, rosacea, psoriasis follow-ups, cosmetic consultations

Not Sure – Please Triage

Patient Email

(Optional)