Refer a Patient

Choose your preferred referral method. We respond to all referrals within 24 hours and coordinate directly with you on acceptance and scheduling.

Primary Referral Methods

For fastest processing and secure transmission of clinical records, we recommend phone or fax referrals:

Phone Referral

Speak directly with our intake coordinator

(832) 510-6059

Secure Fax

HIPAA-compliant fax line

(832) 369-7271

Download Referral Form PDF

Online Referral Form

Submit your provider information below to initiate a HIPAA-compliant referral. We will contact you within 24 hours to securely collect patient information and clinical records via encrypted methods.

HIPAA Compliance Notice

This form collects ONLY provider/referrer information. DO NOT enter any patient names, medical history, clinical details, or protected health information (PHI). Patient information will be collected securely after we contact you.

What Information Do You Need?

To expedite acceptance and scheduling, please include:

Patient Demographics

  • • Full name, date of birth
  • • Contact phone number
  • • Complete home address
  • • Insurance information

Clinical Information

  • • Wound description (location, type, duration)
  • • Relevant diagnoses (diabetes, PVD, etc.)
  • • Current medications
  • • Recent labs if available

Don't have all this information? That's okay. Submit what you have, and we'll work with you to gather the rest.

After You Refer

1

We Respond Quickly

Within 24 hours, we contact you to confirm acceptance and verify insurance eligibility.

2

Patient Contact

We reach out to the patient/caregiver to schedule the initial in-home assessment, typically within 48-72 hours for routine wounds, same/next-day for urgent cases.

3

You Stay Informed

After the initial assessment, you receive a comprehensive visit note with wound staging, treatment plan, and our clinical recommendations. Regular updates follow throughout care.

HIPAA Compliance

All referral communications and medical records are transmitted via HIPAA-compliant secure methods. We maintain strict privacy standards and provide Business Associate Agreements upon request.

Questions About the Referral Process?

Our intake coordinator is available to discuss referral requirements, insurance verification, or coordination needs.

Call (832) 510-6059For Referring Providers
Call Now: (832) 510-6059