Download our Physician Referral Form

Please fax this form to our office, along with a referral/prescription for requested services. The prescription must be presented at the time of appointment for Medicare reimbursement.
 
Form: Physician Referral Form

St. Cloud:

Maple Grove:

Phone: (320) 310-0668 Phone: (763) 260-8835
Fax: 320-252-0365 Fax:763-432-5498

 
St. Cloud Location

 
Maple Grove Location