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How to Refer a Lymphedema Patient

Welcome! Choose your referral guide path based on your role

For Physicians

Follow these streamlined steps for referring a patient to our lymphedema treatment program:

DOWNLOAd the files below: 

Physician Order Form

List of Required Documents

complete the forms and document requirements:

  • Ensure the Physician Order Form is fully completed and signed by the physician.

  • Complete the Document Requirements, ensuring all the needed information listed are prepared.

Submit the Form and documents

  • Email the completed forms and documents from the checklist to our email. 

  • Alternatively, you can fax them to 214-594-9987.

RECEIVE UPDATE

Our scheduling team will review the submitted documents and contact you with an update regarding the next steps.

If you need assistance regarding your Lymphedema Referral, please check our contact directory


For Home Health Agencies

DOWNLOAd the files below: 

Therapy Referral Form

Choose HOW TO SUBMIT

Decide whether to:

  • Email with an attachment

  • Email without an attachment

  • Fax

  • Kinnser E-Referral

Submit the Referral

With Attachment:

  • Email the filled-out form as an attachment to our email. 

  • Alternatively, you can fax them to 214-594-9987.

Without Attachment:

  • Directly email the necessary patient information contained in the Therapy Referral Form to our email. 

  • Send and E-Referral to our Kinnser

RECEIVE UPDATE

Our scheduling team will review the submitted documents and contact you with an update regarding the next steps.

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