Refer a Patient

Thank You for Your Referral

Thank you for your trust in us to care for your patients. We appreciate your referral. For your convenience, there are three simple ways to refer a patient:  

Refer by Phone

(682) 936-2544
For prompt attention, ask for first available appointment. Provide patient’s insurance provider and plan, and if the patient has had any imaging or diagnostic tests.

Refer by Fax

(866) 853-2870
Provide patient’s information, insurance provider and plan, and any clinic notes.

Refer by E-Mail

Complete and send the form below.
Our office will be in touch you for any additional information required to process the referral.

Patient Referral Form

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
Patient Name*
Schedule Consultation Requested for*
Schedule Patient*
Procedure/Treatment requested

Procedure/Treatment requested

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Accepted file types: jpg, jpeg, gif, png, pdf, docx, doc, zip, Max. file size: 3 MB, Max. files: 5.
    Consent*

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    More Living.

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