For your convenience, we have made a Referral Form available
Due to liability reasons, (TO ENSURE PATIENT CONFIDENTIALLY AND TO FOLLOW
THE PROVISIONS OF THE PROTECTION OF PRIVACY ACT) this form must be
printed and mailed as a hard copy to the above address.
Follow these 5 easy steps to download and
complete the form:
- Right click on the
Referral Form link, and select "Save Target As..." (I.E.)
or "Save Link As..." (Netscape).
- Save the form to a
location on your hard drive.
- Once download is complete,
double click it. When asked to choose between Enable/Disable Macros,
choose Macros Enabled and fill in the form.
- Once you've completed the
form, save it and print out a hard copy.
- Mail the printed form to ACTIN Health and Rehabilitation
at the mailing address (above).
Form (Word Doc.)
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All Rights Reserved.