Referral Forms

How do I refer my patients?

  1. Check patient qualifications
  2. Download and complete the form (PDF, 136 KB)
  3. Fax the form with History and Physical to the nearest clinic where the patient lives
  4. Please be sure to include diagnosis(es) and any other pertinent records when faxing the referral forms
Please contact a California or Washington office for fax numbers or if you need more information.