TMS Provider Referral Form

how to make a referral

Refer a patient by phone: Providers can call 608-713-9898, option 5 for patient referrals.

Refer a patient online: To refer a patient online, please complete the information requested below. This is a secure form, and the information you provide will enable us to assist your patient as efficiently as possible. * denotes required field.

For further questions or concerns we can be reached by phone at (608) 713-9898 option 5, or through email.

    Referring provider office information
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    patient’s information
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