Physician Referral Form

Exceptional Service, Excellent Results with Caring and Friendly Therapists
  • 2576 Lawrenceville Suwanee Road
    Suwanee, Georgia 3002
    Phone: (770) 962-4043
    Fax: (770) 962-4045
  • 4195 South Lee Street, Suite
    Buford, GA 3051
    Phone: (770) 932-303
    Fax: (770) 932-303
PATIENT INFORMATION

Relevant diagnostic testing and results:

Physical Therapy Evaluate and Treat

Life Fit Assessment and Training

Be better than fit,………….. be ‘LIFE FIT

Frequency of Treatment: 1 2 3 4 5

I hereby Certify these services as medically necessary for the patients plan of care: