Referrals

Refer a Patient to Odom Health & Wellness

Referring Provider Contact and Assistance Guide

Thank you for the opportunity to participate in the care of your patient. We are very happy to be part of your patient’s clinical team and we’re here to help. We can provide you with prompt, direct assistance with: Insurance Verification, Authorizations – Insurance Questions, How to Refer / Why to Refer / When to Refer.

For Immediate Assistance

Phone: 952-224-1919

Fax: 952-746-5655

Email: [email protected]

Otherwise fill out the form below:

Contact Us

Patient Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth(Required)

Chief Complaint(Required)

Diagnosis

Recommended Services(Required)

Orthopedic Consultation - Dr. Odom

Physical Therapy - Eval & Treat

Platelet Rich Plasma Therapy (PRP)

Mesenchymal Signaling Cell (MSC) Injection

Prolotherapy

Massage Therapy

Dry Needling

Personal Training

Therapies and Treatments at provider’s discretion

Please upload copies of any diagnostic reports (MRI, CT, X-Ray, etc.,) as well as the most recent physician's notes, patient demographics and insurance information related to the patient along with this request form. (or fax files to: 952-746-5655)

Max. file size: 256 MB.

Referring Provider's Name(Required)

First Last

Referring Provider's Phone(Required)

Referring Provider's Email(Required)

Comments

This field is for validation purposes and should be left unchanged.