Monday - Friday 8AM–5PM
PLEASE FAX THE FOLLOWING TO 800-721-2101
SIGNED REFERRAL FOR TREATMENT
LAST PHYSICIAN NOTE
UPDATED MEDICATION LIST
We are Medicare providers and take most private insurance. Private pay is an option if no insurance is available and this and all payment arrangements can be made prior to treatment beginning. We provide insurance verification and copayment information if required free of charge prior to treatment beginning.