Patient Portal Authorization

To request access to our Patient Portal, please print and complete the Email Request form and return it to us. You must return the form in person for verification.

Email Request click here.

Referral Request Information

If your insurance requires a referral before you can be seen by a specialist, our office is available to assist you. Please allow ample time for your referral to be processed prior to your appointment with your specialist. We do not process referrals on weekends or holidays.

To request a referral, please call your physician's office and be prepared to give the following information:

Your name and Date of Birth
Daytime phone number
Name of insurance & ID Number
Name of specialist / facility
Reason for specialist visit

Some referrals can now be done electronically (i.e. Aetna and Keystone) you do not need to take a paper referral to the specialist’s office. Referrals that cannot be done electronically will be available for pick-up at your primary care office during regular business hours.

Referral Requests click here.

Records Release Information

To request your Medical Records, please print and complete the Records Release form and return it to us. You may return the form to your provider's office or you may fax it to us at 610-594-2625.

Records Release click here.