To place an order or referral complete our HIPAA Patient Intake Form, and an Order Form
Please download and complete the appropriate form below, then submit it along with the following required documents:
Once complete, fax all documents to our confidential fax line at 747-400-4237.
If you need help completing the forms or have any questions, please call 337-236-4377 or contact us at our toll-free number: 800-282-1757.
We are here to assist you and ensure you receive the coverage and care you deserve!