This form will allow you to submit a request for referral online. Once you have completed the form and click on the submit button you will receive a confirmation of your submission. All referral requests are handled by our referral coordinator. Routine referrals are obtained every Friday. We ask that you request referrals a minimum of 1 week prior to the scheduled appointment. All urgent requsts should be requested by contacting our referral coordinator by calling the office (305) 448-8134 between 9:30 AM and 4:00 PM, Monday through Friday.