Submit a Referral

Fax: (888) 219-8102

Download our convenient fillable PDF referral forms for a specific condition or medication below, then simply fax or email to our office along with the necessary patient documentation. We’ll take care of verifying the patient’s insurance coverage and working through the prior authorization process if needed.

Need a different form? We’re here to help!

If you would like to see a referral form that is not listed above, please contact us.