Fast. Simple. Secure.

Our HIPAA-compliant online referral system is secured with 256-bit AES encryption, the same encryption level used by most online banking systems and the same SSL technology that fuels most SecureFax systems already in use by hospitals.

Use the form below to verify patient eligibility for Medical Nutrition Therapy (MNT) and Diabetic Shoes. After you submit your form, we'll contact the acting physician and make sure everything else is taken care of.