Fax Referral Form Informational Patient Handouts

Physicians may refer a patient to our office by telephone or by fax, whichever is easiest for your office. We have developed a free Fax Referral Form and Informational Patient Handouts to assist your office staff, using the information and suggestions from some of our referring offices.

Informational Patient Handouts have all been designed to provide information to your patients and thereby save you and your staff time when referring patients to Pain Diagnostics and Treatment Center, PA.

The form is in Adobe Acrobat pdf format. If you do not already have Adobe Acrobat on your system, you can download it free by clicking on the Adobe Acrobat link at the bottom of this page.

Register for our free Informational Patient Handouts
Simply complete this short form to access our Free PDF downloadable forms:

Name of Practice:
Name:
Phone:
Email:
Address:
City:
State:
Zip:

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