DRCR Patient Referral

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If you know anyone who may benefit from our services, please refer them to us by filling out the form below. If you have any questions about the referral process, please call DRCR at 1-877-770-6671.

Information for referring providers:

  • A physician or nurse practitioner referral is required for the majority of services at DRCR
  • It is preferred that the referral comes from the treating nurse practitioner or physician

Information for your patient:

  • Please ensure your patient is aware that the referral is being made
  • Once the referral is ready for scheduling, DRCR will make a call attempt to the patient and leave a voicemail, if consent is provided. If the patient cannot be reached, the referring provider will be notified. Note the number will appear as a blocked caller ID

How to submit a referral:

  • Please fill out the referral form below completely, including as much information as you can. Referrals that are received without enough information will be held until the needed information is obtained.
  • You will receive confirmation of referral receipt when the referral is processed by DRCR.

If your patient is in need of immediate help, please direct them to the nearest emergency department or call 911.

Note: First and Last Name if Individual
Address line 1
Address line 2
Private insurance company name

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