Intake & Referrals

We have two easy ways to submit a referral for a new patient. Both options can be completed by the patient, the patient's guardian, or a referring healthcare provider.

OPTION A: Submit paperwork electronically... all online!
Estimated Time to complete: 20-30 minutes
Estimate processing time: 1-3 business days
Estimate trees killed: ZERO! 🥳

OPTION B: Submit all paperwork and documentation manually via email, mail, or fax
Estimated Time to complete: 45 minutes to 2 hours!
Estimate processing time: 3-6 business days
Estimate trees killed: MORE THAN ZERO! 🥺

Option A

STEP #1

STEP 2

Once you have completed the GoogleForm above, click one of the buttons below to complete and sign your Consent Form. We cannot schedule you for an appointment until your Consent Form is received.

Consent Form Electronic (Sign via Adobe Sign)

Consent Form (Downloadable)

STEP 3

Click the button below to submit the patient/guardian photo ID, all insurance cards, and any other pertinent documents such as custody or POA documents:

Electronically submit ID & Insurance Cards

STEP 4

We will process your information and reach out to you soon....

(Please be sure to check your spam)

Talk to you soon! 😁

Option B:

Download and Print Forms to Manually Complete and Submit

If you do now wish to complete your forms electronically, or are otherwise unable to; you may click the link below to download a PDF version of our Consent and Demographics forms. You can print them out, complete and return via mail, fax or email as instructed on the forms.

Please note we cannot process your intake forms until they are completed and we have copies/photos of the following:

Front and back of photo ID (patient or guardian)
Front and back of each insurance card, including Medicare and/or Medicaid ID cards.
Any pertinent documents such as custody, POA or other legal documents