Physician Referral Form

Physician Referral Form

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.

St. Cloud Location

Phone: (320) 310-0668
Fax: 320-252-0365
 

Maple Grove Location

Phone: (763) 260-8835
Fax:763-432-5498
 

Hudson Hospital and Clinic Location

Phone: (715) 760-9327
 

Westfields Hospital Location

Phone: (715) 243-2600
 

Amery Hospital Location

Phone: (715) 268-8000