Online Referral Form

You may refer patients to our office by filling out our secure online Referral Form. After you have completed the form, please make sure to press the “Submit” button at the bottom to automatically send us the information. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.

Online Referral Form

 

Online Referral System

MyPBHS Collaborator Portal – Better Manage Patient Cases Online!

Please CLICK HERE to submit a new referral to our office or to access patient cases through Collaborator.

This website will allow you to refer patients to our office and to collaborate with us on case development. Due to stringent HIPAA requirements, you must have an individual user name and password for access.

Visit our helpful support pages or learn more about our secure MyPBHS Collaborator referral system.