For use by providers and their staff
Someone will respond to your request within 24 hours, or the next business day. If your referral or consultation request must be accommodated immediately, do not use this form. Please call 1-800-342-5748 if you'd like your patient to be seen within the next 24 hours.
Thank you for allowing us to participate in caring for your patient. We will contact you regarding this referral within 24 hours (or the next business day).