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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

Referral Checklist

complete the forms and checklist:

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

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  • Complete the Referrals Checklist, ensuring all documents 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.


For Home Health Agencies

DOWNLOAd the files below: 

Therapy Referral Form

Choose HOW TO SUBMIT

Decide whether to:

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  • 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.

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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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