Physician Referral

Please select one of the following:

 1. Send a fax of a physician prescription/referral info (e-fax: 855-933-2591).

2. Print the physician referral form, fill out, and fax along with H&P if available.

Self Referral

You can refer yourself to our clinic. We may need to obtain a physician’s order or other relevant information before or after the initial evaluation depending on your insurance, medicare eligibility, and/or medical necessity of treatment areas of interest. You can go ahead fill out and submit the form available at Therapy Consultation. You can also indicate whether you are interested in a free consultation before considering a first appointment. You will be contacted via email or phone. HIPAA compliant text messages are available if preferred.

Thank you for your referral!