Physician Referral Form

When it comes to medical care, only the best treatment and care will do for your patients. Lynx Healthcare partners define “excellence” in medical care. Rest assured your patients will be given the same level of care we would extend to our own families.


Please note: It may take a few minutes to load the form if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.

Get Adobe Reader

All referrals must include the following for prompt processing:

  • Patient Demographics
  • Insurance Information (copy of card)
  • Most recent chart notes
  • Recent radiology (If patient does not have recent radiology please order and have reports faxed to our office)
  • Department of Labor and Industries cases must include claim managers name and contact information

If you would like to discuss a particular patient before referring them to us, please do not hesitate to call.