For Physician Offices

Please fully complete the correct referral form in order for us to serve you and the patient efficiently. Once you have completed this form and obtained the necessary medical records, please fax or email using the information provided on the form.

Appointment scheduling is determined by the severity of illness and is scheduled directly with the patient. Once we have secured an appointment with the patient you will receive notification of the date and time of the appointment. If we are unable to reach the patient by the third phone call; we will notify your office so that follow up can occur with the patient.

We thank you for your referral and we appreciate the opportunity to serve you and the patient.

Physician Referral Form - All Clinics

Physician Referral Form - Fort Smith

Physician Referral Form - McAlester

Physician Referral Form - Muskogee

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