Use this form to refer a patient of any age - adult or pediatric - who has agreed to be contacted. If referring a minor, we ask that you list a parent/guardian as the primary contact. We will send a gentle email inviting the patient (or their parent/guardian) to connect.

If you need to coordinate care with our team regarding a shared patient, the patient must complete a Release of Information (ROI) form to authorize communication.

To make this easier, we’ve provided direct access to the form. You’re welcome to pull it up during an appointment so the patient can complete it in real time, ensuring seamless collaboration.

Interested in collaborating? Use this form to request a meeting or learn more about our services.