(Practice)
(Specialty)
(Location)
(Phone)

Referral Form

Please download and fill-out our Patient Referral Form. After you have completed the form, please fax a copy of this referral to:

  • McDonough office: 770-474-9395
  • Griffin office: 770 229-4344

Thank you!

Technical Note:

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2340 Patrick Henry Pkwy. Suite 100 • McDonough, GA 30253 | Phone: (770) 474-1260 • Fax: (770) 474-9395
227 South Tenth St. • Griffin, GA 30224 | Phone: (770) 229-8255 • Fax: (770) 229-4344