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Patient Referrals

The best way to refer a patient to Hartmann Health Medical is by submitting the form below or by sending your own referral form to either our email or fax: 

Referral form

Provider Contact

Patient Contact

Patient Date of Birth

Parent/Guardian (if applicable)

Internal DEA Compliance

Are you a DEA registered provider? (We will not ask for your DEA information)
Have you seen this patient in-person?
No, I have evaluated this patient virtually
No, I have never evaluated the patient

Clinical Question

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