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Referrals Forms

The sincerest compliment that our practice can be given is a referral from another healthcare provider.

Physiotherapist
Wheelchair referral.png

PT Evaluation Referral

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OUTPATIENT DEPARTMENT PRESCRIPTION FORM

Our Insurance

Who to Contact?

Any questions or concerns with referrals please contact us at (559) 713-6461 or vapt@vaptpc.org

What we look for in a referral:

  1. Fax cover or cover sheet with appropriate clinic contact information.

  2. MD Order

  3. Face Sheet

  4. Physical and History with appropriate Dx

  5. Insurance Information

Take Note:

Please complete appropriate referral form and return with Demographics and  H&P.  Referrals can be faxed to (559) 713-6012 or emailed to vapt@vaptpc.org.

Our Worker's Comp

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