Doctor Referrals

Thanks for referring to our team at Rebound Total Health. Once submitted, our intake team will connect with the client within 1–2 business days! Please let them know to check their spam folder!

Physician Referral Form

Physician Name

Physician Phone

Physician Email

Client Name

Client Phone

Client Email

What service is the client interested in?

Reason for Referral

Include primary concerns.

Anything we should be aware of?

Current medications (if relevant) | Diagnoses (if relevant) | Risk concerns (self-harm/safety) | Anything important clinically or contextually | Client Preferences

If you are human, leave this field blank.

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