To request assistance for ‘Routine Care’ please explain what care is needed, who the care is for (yourself or a family member), if you are currently receiving care for this matter elsewhere, and any provider or facility you prefer to be treated by. Once submitted, a member of the Medical Group Team will contact you as soon as possible, during normal business hours.
Examples of Routine Care:
- Primary Care Provider Recommendation
- Scheduling Expedited Care for Basic Illness / Injuries
- Follow Up Care
- Second Opinions on Elective Procedures
- Non-Emergent Specialist Referrals.
Routine Care Contact should NOT be used for life threatening illness / injuries, traumatic injuries, time sensitive medical treatment or conditions that would normally be treated in an Emergency Room. This form is not HIPAA compliant, please avoid submitting protected healthcare information.
