Refer a Patient

Thank you for referring to LGTC Group. If you feel your patient might benefit from one of our services, please complete this form. Please be assured that this referral will be handled in a way that respects your patient’s privacy and complies with HIPAA regulations. You may also make a referral by calling 800-913-2615. We will reach out directly to your patient to schedule a screening.

This form is only intended for primary care or other health providers to refer patients.
If you are a patient and would like to schedule an appointment, please click here.

Patient Information

    Service needed (Required)

    Additional referral Information (reason for referral, main complaint, or any other relevant information)

    Referring Provider Information