Online Referral Form
Making a Referral
Parents & Caregivers
Making a referral for your child is easy!
Follow the following steps to get started!
Please have your child's insurance and physician information available.
Call us at (404) 606-3755. We will gather all the insurance and physician information we need from you to request a doctor's order.
We will contact your child's doctor and insurance company to request authorization to evaluate your child.
After the signed orders are received by our administrative team we will contact you to schedule an evaluation.
Physicians & Referral Coordinators
You may submit a referral on our easy to use online referral form below or:
Fax the referral to (770) 696-1065
Email the referral to email@example.com
After you submit the referral form below we will contact you to confirm if the referral can or cannot be staffed within 48 hours. It's that simple!
Call us at (404) 606-3755 or email us at firstname.lastname@example.org
Monday - Friday 8:00 am - 5:00 pm
Saturday By appt