Patient Consultation Information
This page is reserved for use by health care professionals who are referring a patient to our offices.
Please fill out the form below and the information will be posted to a confidential database and shared with the
appropriate Associated Therapists provider.
PLEASE BE CERTAIN THAT YOU HAVE RECEIVED A "RELEASE OF CONFIDENTIAL INFORMATION" FROM YOUR
PATIENT BEFORE SUBMITTING ANY INFORMATION TO US.
Page Last Updated: 09/04/11