Referral Form and Consents:
If you are NEW TO EARLY BIRD or RETURNING AFTER A BREAK IN SERVICE, please fill this NEW PATIENT REFERRAL PACKET AND CONSENTS and someone will contact you in 48 business hours to see how we can help you and your family! CLICK HERE.
If our online referral form gives you trouble, please call 704-846-0262 to make a referral
Si es NUEVO EN LA RESERVA ANTICIPADA o REGRESA DESPUÉS DE UNA INTERRUPCIÓN EN EL SERVICIO, complete este PAQUETE DE REFERENCIA DE PACIENTE NUEVO Y CONSENTIMIENTOS y alguien se comunicará con usted en 48 horas hábiles para ver cómo podemos ayudarlo a usted y a su familia, CLIC AQUÍ.
Si nuestro formulario de referencia en línea le causa problemas, texto 704-995-2900.
__________________________________________.
If you are an physicians, case manager, social worker, or an advanced medical provider wanting to make a referral for your patient/client, please CLICK HERE. Be sure to fill out as many of the blanks as possible.
We will still need a referral form and consents from the families should we pick up for services
__________________________________________
ESTABLISHED PATIENTS
Consents for established patients, CLICK HERE.
Consentimientos para pacientes establecidas, CLIC AQUÍ.
__________________________________________
Current Early Bird families – if your insurance has changed, please CLICK HERE to update us! Thanks!
__________________________________________
Additional Documents for Existing Patients
Release of Healthcare information form CLICK HERE. Formulario de divulgación de información médica HAGA CLIC AQUÍ.
Preferred Provider Letter CLICK HERE. Carta de proveedor preferido HAGA CLIC AQUÍ.
Backpack Notebook Consent Form CLICK HERE.
Consentimiento del cuaderno para la mochila CLICK HERE.
Early Bird Confidentiality Form CLICK HERE.