IMPORTANT FORMS
FAX INFORMATION: 785.856.2349
EMAIL: tonidetherage@gmail.com
Referral Forms
For your convenience we have our referral form online.
This gets us the information a lot faster and saves you time!
This gets us the information a lot faster and saves you time!
If you're having trouble completing the referral form online, you may download a .pdf version of the form. Our fax number is 785.856.2349.
| referral_form.pdf |
Authorization to Release Information
To get a release form, just click on the button below to download the authorization to release information form. Please complete this form and fax to 785.856.2349 or bring in to our office.
