Doctor’s Referral Form

Online Referral Form

You may refer patients to our office by filling out our secure online Referral Form. After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.

Bismarck – Online Referral Form

Fargo or Jamestown – Online Referral Form

Grand Forks – Online Referral Form

Printable Forms

Bismarck – Download Our Patient Referral Form

Fargo or Jamestown – Download Our Patient Referral Form

Grand Forks – Download Our Patient Referral Form


Fax: 701-222-2329


Fax: 701-239-0034

Grand Forks

Fax: 701-775-4530

To send a referral to us via email, please use the following link to access our secure message portal:

Click Here – Secure Message Portal