MAIN SOUTH FLORIDA FACILITY

HOW TO GET STARTED

THE EASY AND SIMPLE PROCESS.

	FAX PHYSICIAN PRESCRIPTION OR ORDER STATING THE FOLLOWING: EVALUATION AND TREATMENT DIAGNOSIS: (Ex: Breast Implant Capsular Contracture) or (Ex: Post-op Lymphedema) or (Ex: Post-op facial edema)
	Please include physician name, physician phone number, and patient name and phone number. FAX TO: (954) 341-7895 (SEE ALSO INCLUDED PRESCRIPTION PAD BELOW FOR EXAMPLE)

CALL THE REFERRAL LINE DIRECTLY: SPEAK WITH AN EXPERT. CALL TO: (954) 341-7875 Hablamos Español, Wir Sprechen Deutsch, Nous Parlons Francais

E-MAIL THE REFERRAL LINE WITH INQUIRIES OR PRESCRIPTIONS. SPEAK TO A MEDICAL PROFESSIONAL Contact the Referral Help Line

FAX:        (954) 341-7895 PHONE:  (954) 341-7875

PATIENT FORMS TO FILL OUT BEFORE YOUR FIRST VISIT

1. CHOOSE YOUR TYPE OF PROCEDURE:

Was this was an ELECTIVE SURGERY (you chose to have surgery ) or RECONSTRUCTIVE SURGERY (you had an accident or medical condition)?

2. PRINT DOCUMENTS:

Please click the documents below that correspond to your situation above, print out all the forms in section, and fill out all yellow areas. Simply fax completed forms or scan and send via email to get started. You can also hand carry forms to your first visit.

TREATMENT FORMS (PLEASE SELECT APPROPIATE FORMS)
forms are provided in PDF form. simply click on the appropiate forms and then print.

NEW PATIENT - ELECTIVE SURGERY
Click here to Download Form for printing

NEW PATIENT - RECONSTRUCTIVE SURGERY
Click here to Download Form for printing

FORMER PATIENTS - DISCHARGED
Click here to Download Form for printing

We look forward to meeting you and helping you achieve your desired results.