Refer a Patient

For Physicians and Practices

Our two-page referral form is fillable on screen. Type in the patient, diagnosis and services, sign it, and send it the way that suits your office. Fax it to 973-759-0557 for any Holsman clinic.

Protecting your patient's privacy: fax is the most secure way to send us a referral. Please don't send diagnoses or other health details by regular text message or unencrypted email.

What Happens Next

1. Our front desk contacts your patient to schedule at the clinic they prefer.
2. We verify the patient's insurance benefits at no charge before the first visit.
3. You receive the evaluation and plan of care for signature when the plan requires it, as Medicare does.
4. Tick "send me notes" on the form and we'll send progress notes too.

New Jersey and New York let patients start physical therapy without a prescription (New York sets visit limits), but some insurance plans require a referral to pay for it. A signed referral helps your patient start without delay.

Refer a Friend or Family Member

Know someone who's hurting, recovering from surgery or worried about falling? Leave their name and number and we'll call them to answer questions and check their insurance. No health details needed, and please ask them first.