Referral form 2 of 2
Online pre-authorization form
Submit referral, client and coverage details so we can secure authorization before services begin. Our authorizations team replies by email.
Before you start
Have these ready
- Referring agency contact details
- Client demographics and address
- Insurance, Medicaid or Medicare identifiers
- Presenting problems and requested type of care
Attach clinical documentation to the email that opens after you submit. All authorization correspondence is handled by email.