Refer a Patient

For clinics, facilities, and home health teams referring patients for mobile specialty wound care.

Submit the patient’s information, wound care needs, and available supporting records through our secure referral form. Our team will review the referral and contact the patient or designated contact to coordinate next steps.

Submit a Secure ReferralDownload Referral Form to Fax

What to include

Patient contact information and care address; insurance information or face sheet; wound location and current treatment; recent clinical notes, medications and allergies; relevant testing and infection precautions; home health agency details, if involved.

Signed referral / order

The referring provider may sign electronically, or your office may upload an existing signed order or send it by fax. A signed referral/order is requested before the initial visit.

Prefer to fax?

Download and print the referral form above, complete and sign it, and fax it with the patient face sheet and available supporting records to 509-209-9032.

Questions? Call 509-209-9033. Please enter patient information in the secure form or send it by fax rather than ordinary email.

Submission does not confirm an appointment. This form is not monitored continuously. Call 911 for a medical emergency.