Provider Referral Form

We accept the following types of referrals:

1) In-Person is a face-to-face appointment with the patient with one of our physicians. This means that patients already live in one of the facilities that we service. We keep a list of facilities we visit on our contact page. We will see the patient within 4-6 weeks of the referral submission and will communicate with the PCP or referring provider via fax, text, or phone.

2) Provider-to-Provider referrals mean that we do not physically see the patient. The referring provider wants a direct consult with one of our physicians.

We recommended using a Provider-To-Provider model in the following situations:

• Patient lives in a residential home or a facility that is not currently serviced by our physicians.

• Patients need treatment quicker than the 4-6 week referral window.

3) Provider-to-Provider (transitioning to In-Person)

You may use a provider-to-provider consult referral to begin treatment and arrange for our physicians to see the patient in person if the patient lives in a facility we serve. This alleviates the 4-6-week wait time and allows more emergent patients to begin treatment plans more quickly.

Patient Information:

POA INFORMATION: