Refer A Patient Patient Info * First Name Last Name Phone * (###) ### #### Reason for Referral Specialty Care Primary Care IV Therapy One Time Consult Other - specify below in case info Case Info * Care Coordination Co-management Transferring Care One Time Consult Is there anything else you would like us to know? Priority * Routine Urgent Referring Provider Info * First Name Last Name Referring Clinic * Phone * (###) ### #### Fax * (###) ### #### Would you like to be called to discuss the case further before seeing the patient? Yes No Thank you for your referral! Please fax the most recent chart note to 1-833-740-3549.If any questions or concerns arise, call or text us at 206-681-1485. We are honored to have an opportunity to provide care for your patient. We will contact your patient within 48 hours (24 hrs for urgent referrals). We are honored to become a part of your patient’s care team.
