Patient Referral

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If you are from a physician's office, please attach the patient's facesheet along with any other relevant medical information at the bottom of the form. Otherwise, you may also directly fax or email us this information along with the order for therapy. 

If you are referring yourself or a loved one who has Medicare, please fill out the physician name and contact information fields. We will reach out to you and the physician's office to acquire orders before beginning treatment.