Thank you for your interest in a referral for your patient. We appreciate your trust in our practice.
We request that a baseline medical work-up be evaluated by your practice prior to our seeing the patient.
We typically recommend a full physical exam, baseline blood work (Complete Blood Count, Chemistry Profile and Thyroid Test) plus any additional indicated medical tests for the behavioral complaint (such as urinalysis for elimination issues).
We will also ask for a copy of the medical history for the patient when the client schedules an appointment, if we have not already received it. All of the files can be attached to the referral form below, emailed to firstname.lastname@example.org or can be faxed to 877.240.4543.
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