Provider Referrals

Secure referrals. Clear next steps.

Send referrals securely, include the right details, and help patients move to the next step with clear follow-through.

Secure portal preferred for referral details and documents
Include patient name, DOB, reason for referral, notes, labs, imaging, and insurance
For urgent same-day referrals, submit first, then call the clinic

Call Support (480) 943-1220

Fax Referral REFERRAL_FAX_NUMBER

HIPAA Reminder Do not email medical info

Provider Referral

Send a provider referral.

Submit referral information so our team can review, route, and coordinate the next step for the patient.

This form must be connected to a secure, HIPAA-compliant endpoint. Do not use regular email for patient-specific referral details.

Referring provider name

Role or title

Office or organization

Office phone

Office fax

Office email

Preferred reply method

What do you need help with?

Message

I confirm this message does not include patient names, dates of birth, diagnoses, insurance IDs, records, labs, imaging, or other protected health information.

Secure referrals. Clear next steps.

Send a provider referral.

Clinic name

Local Arizona phone number

Hours of operation