Physician Referrals

If you do not use our referral form, please be sure that your referral is legible and includes:

• Patient's full name & date of birth
• Patient's contact information
• Patient's insurance information - we accept Aetna, BCN, and BCBS with the exception of Blue Cross Complete.
• Patient's diagnosis/suspected diagnosis
• Type of service being requested
• The referring physician’s printed name, NPI, signature, and date
  • Referrals expire after 90 days, please be sure to send a non-expired referral.
  • HMO referrals must be signed by the patient's PCP.

Then, please direct your patient to the New Patient Intake page.