Download, fill out and fax the appropriate referral form and clinical documentation to: Specialty physicians: (937) 3418991(fax). Physical therapists may accept faxed referrals as an original.Physical therapists may accept faxed, referrals as an original. How to fill out the Advanced Physical Therapy Referral Form? 1. Enter patient personal details including name and address. 2. If you know someone that could use our help, simply fill out the form below and we will send them information about our services.
