Refer a Patient

Is this urgent?

If so, please call us at 919-752-7335

Who is the patient?

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Upload clinical documents

You may also fax documents to us at 919-924-0275

Who is a guardian we can contact?

Does have a legal guardian?

Who is referring this patient?

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Who are you, and how do we reach you?

This is how we will contact you regarding this referral.
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Patient Insurance (Optional)

It would be helpful to upload any insurance documents.

Or, you can optionally enter their plan information.

Safety & Custody Concerns (Optional)


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