top of page

Referrals Forms

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

OUTPATIENT DEPARTMENT PRESCRIPTION FORM

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 Diagnosis

  5. Insurance Information

Take Note:

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

Accepted Insurance

LaSalleLogoSquare (1).png
Calviva_4_-removebg-preview.png
Medicare_nbg.png
ihp-logo.png
american-specialty-health-ash-logo-vector__1_-removebg-preview.png

Accepted Insurance For Workers' Comp 

Hartford.png

Copyright © 2023 Vincent Alarcon PT

bottom of page