Step 1

We need the following information about your patient:

1. Demographic Data

2. Copy of Insurance Card or Third-Party Payor Information

3. Relevant Medical Records Providing Reason for Referral

4. Imaging Reports & Associated Images

Step 2

Fill Out Our New Patient Referral Form HERE

Step 3

Email Referral Form to referrals@aptivahealth.com

OR

Fax Referral Form:1-855-859-0123

Questions? Call us today!
1-844-999-3627