Make a Referral

Adjusters and Case Managers, please use the following form to order any product or service.

Please fax your prescription for the requested services to 844-821-3632. You will be contacted by a Patient Care Coordinator to verify this order prior to processing.  If you do not have a prescription, please indicate this on the referral form and we will contact the referring physician.

Orders are received and processed the same day, however, accounts are updated in the system by the next business day.

Orders are processed 5 am – 5 pm PST. If it is after hours and this order is urgent, please call 844-261-2996 and have us paged. We are happy to assist you.

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