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PROVIDERS ONLY - REFER A PATIENT

NOTE: This page is for providers only. If you are a patient or a new patient wanting to schedule an appointment, please click on the make an appointment tab above or call us at 361-854-0811. Thank you. 

Providers, please fill out the following form below to submit your referral requests, including uploading any necessary documentation to give our physicians as much information as possible to best treat your patients in a timely manner.

* indicates a required field

Is the patient the policy holder?
Upload secured documents here.
Site of injury:

Thanks for submitting!

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