Insurance Authorization for Referrals 

Before completing this form, please make sure you have already discussed your referral with the specialist office. They will confirm if your insurance plan requires insurance authorization prior to your visit

If so, then we need to secure insurance coverage for the costs associated with the specialist visit on your behalf. To initiate the insurance authorization process, kindly use this link and complete the required form. If the appointment is not scheduled yet, use today's date. Your submission will be processed within 7 business days

Thank you so much for your cooperation!