Referral Instructions

1. Click on the “SPA Referral Form” link below (DON’T CLICK THE DOWNLOAD BUTTON) 
2. Fill out the form online 
3. After the form is filled out, click the “print” icon in the top right corner (don’t worry, this will not print the document)
4. Change the “Destination” to “Save as PDF” 
5. Click “Save“
6. Upload the PDF & other chart notes (if available) below, under “Upload Referral Form & Other Documents Here“
7. After uploading documents and entering the contact information, click “SUBMIT“

 IF THERE ARE ANY ISSUES, WE WILL CONTACT YOU

Referring Provider Form

SPA Referral Form

Upload Referral Form & Other Documents Here: