{"id":928,"date":"2022-01-23T15:43:46","date_gmt":"2022-01-23T22:43:46","guid":{"rendered":"https:\/\/earlybirdonline.com\/?page_id=928"},"modified":"2025-08-27T11:50:51","modified_gmt":"2025-08-27T18:50:51","slug":"forms","status":"publish","type":"page","link":"https:\/\/earlybirdonline.com\/?page_id=928","title":{"rendered":"Forms"},"content":{"rendered":"

Referral Form and Consents:<\/h2>\n

If you are NEW TO EARLY BIRD or RETURNING AFTER A BREAK IN SERVICE<\/span>, 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!\u00a0 CLICK HERE.<\/b><\/span><\/a><\/h3>\n

\u00a0If our online referral form gives you trouble, p<\/strong>lease call 704-846-0262 to make a referral\u00a0<\/strong><\/em><\/h4>\n

<\/h3>\n

Si es NUEVO EN LA RESERVA ANTICIPADA o REGRESA DESPU\u00c9S DE UNA INTERRUPCI\u00d3N EN EL SERVICIO<\/span>, complete este PAQUETE DE REFERENCIA DE PACIENTE NUEVO Y CONSENTIMIENTOS y alguien se comunicar\u00e1 con usted en 48 horas h\u00e1biles para ver c\u00f3mo podemos ayudarlo a usted y a su familia, \u00a0CLIC AQU\u00cd.<\/b><\/span><\/a><\/span><\/h3>\n

Si nuestro formulario de referencia en l\u00ednea le causa problemas, texto 704-995-2900.<\/span><\/em><\/h4>\n

<\/h3>\n

__________________________________________.<\/p>\n

If you are an physicians, case manager, social worker, or an advanced medical provider wanting to make a referral for your patient\/client, please \u00a0CLICK HERE<\/span>.<\/a>\u00a0 Be sure to fill out as many of the blanks as possible.<\/h3>\n

We will still need a referral form and consents from the families should we pick up for services<\/h3>\n

__________________________________________<\/p>\n

ESTABLISHED PATIENTS<\/h2>\n

Consents for established patients, CLICK HERE.<\/b><\/span><\/a><\/h3>\n

Consentimientos para pacientes establecidas, \u00a0CLIC AQU\u00cd.<\/span><\/a><\/h3>\n

__________________________________________<\/p>\n

Current Early Bird families – if your insurance has changed, please<\/em><\/strong>\u00a0CLICK HERE<\/strong><\/span><\/a><\/strong>\u00a0to update us! Thanks!\u00a0<\/em><\/strong><\/h2>\n

__________________________________________<\/p>\n

Additional Documents for Existing Patients<\/strong><\/span><\/h3>\n

Release of Healthcare information form <\/strong>CLICK HERE.<\/span><\/a>\u00a0<\/b>Formulario de divulgaci\u00f3n de informaci\u00f3n m\u00e9dica<\/strong> HAGA CLIC AQU\u00cd.<\/b><\/span><\/a><\/span><\/p>\n

Preferred Provider Letter<\/strong>\u00a0CLICK HERE.<\/b><\/span><\/a>\u00a0\u00a0Carta de proveedor preferido<\/strong>\u00a0HAGA CLIC AQU\u00cd.<\/b><\/u><\/a><\/span><\/p>\n

Backpack Notebook Consent Form <\/strong>CLICK HERE.<\/strong><\/span><\/a><\/p>\n

Consentimiento del cuaderno para la mochila <\/strong>CLICK HERE.<\/strong><\/span><\/a><\/p>\n

Early Bird Confidentiality Form <\/strong>CLICK HERE.<\/span><\/a>\u00a0<\/b><\/p>\n","protected":false},"excerpt":{"rendered":"

Referral Form and Consents: If you are NEW TO EARLY BIRD or RETURNING AFTER A BREAK IN SERVICE, please fill … Continue ReadingForms<\/span><\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-928","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/earlybirdonline.com\/index.php?rest_route=\/wp\/v2\/pages\/928","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/earlybirdonline.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/earlybirdonline.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/earlybirdonline.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/earlybirdonline.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=928"}],"version-history":[{"count":60,"href":"https:\/\/earlybirdonline.com\/index.php?rest_route=\/wp\/v2\/pages\/928\/revisions"}],"predecessor-version":[{"id":932,"href":"https:\/\/earlybirdonline.com\/index.php?rest_route=\/wp\/v2\/pages\/928\/revisions\/932"}],"wp:attachment":[{"href":"https:\/\/earlybirdonline.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=928"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}