To submit a referral or request for services, please do the following:
- Download our referral form using the button below:
- Fill it out using Adobe Reader.
- If using Microsoft Edge – On the “downloads bar” at the bottom of your browser window, click on the three dots next to the file name, then click on show in folder.
- If using Google Chrome – On the “downloads bar” at the bottom of your browser window, click on the up arrow next to the file name, then click on show in folder.
- Once you are in your downloads folder, right click on the file and select Open With -> and then select in Adobe Acrobat Reader.
- (Please do not open and fill out the form directly in your web browser. This sometimes creates issues for us when we process the document afterwards.)
- Save your work and close the referral form.
- Send the Referral Form to us securely using the following link:
If you would like a copy of our HIPAA Statement for your records, or any of our other Policy Statements, you can find them here: