Type (Circle): DIS. OBS. Online Referral Forms, Physicians, Attorneys, Worker's Compensation, Printable Referral Form Download, Workers' Compensation.Referral certification is not a guarantee of payment. If you are a therapist and would like to refer a client to WIN Family Health please select and complete the applicable electronic referral form below. Please include your full name, credentials (e.g. , LCSW-C, MD, RN), and the date in the signature box for the referral to be processed successfully. You can download the patient forms and complete them prior to your first visit. Then, bring the packet with you when you come in for your appointment. Download our referral form. Check out our physical therapy referral form selection for the very best in unique or custom, handmade pieces from our templates shops.