Referrals

To discuss an individualized course of therapy in one of our care centers, fill in the following fields and we’ll contact your office.

* Referring Physician
* Requested Service
* Requested Center - 1st Choice
* Requested Care Center - 2nd Choice
* Requested Care Center - 3rd Choice
* Hospital
* Hospital Admin Date
* Hospital Diagnosis
* Patient name
* Date of Birth
* Height (ft, in)
* Weight (lbs)
* Pre-hospital Function
* Current Ambulatory Status
* Rehab Comments
* Medications
* Primary Pay Source
* Secondary Pay Source
* Patients Doctor
* Expected Length of Stay
* Primary Contact Person
* Contact Phone
* Enter Auth Code

(Nurses and practice manager contact process requires additional discussion.)

FOR MORE INFORMATION, CALL 864.269.3725 OR EMAIL US HERE.