Patient Referral Form
Please use this form to refer a patient from your practice to Total Body Physical Therapy. Complete all of the information requested in the form below. Please note that the asterisk (*) items are required to complete your referral request. Once your referral has been submitted, we will contact the patient within 24 hours (Monday – Friday) to schedule an appointment.
Referring a patient for a work related injury? Use our Workers’ Compensation Appointment Form.
We look forward to continuing to provide the expert care you have come to expect from Total Body Physical Therapy.