Physician Referrals

Refer a Patient

Referring a patient to Reliant First Healthcare Services is simple and fast. We handle insurance verification, scheduling, and paperwork on your behalf.

How It Works

Simple 4-Step Process

Submit referral

Complete the form below or fax to (972) 479-1501.

Insurance verified

Coverage verified within 24 hours.

Patient contacted

We reach out to the patient or family.

Care begins

A clinician visits and initiates the care plan.

Referral Form

Submit a Referral

Fields marked * are required. You may also fax to (972) 479-1501.

Referring Provider

Provider Name *

NPI Number

Practice / Hospital *

Phone *

Fax

Patient Information

First Name *

Last Name *

Date of Birth *

Phone *

Primary Diagnosis *

Services Requested *

Insurance *

Member ID

Clinical Notes

Fast referrals

Fax referrals to

(972) 479-1501

Call us

(972) 479-1500

[email protected]

What we need

✓

Physician's order / 485

Signed order for home health.

✓

Face-to-face documentation

Required for Medicare/Medicaid.

✓

Insurance information

Patient's insurance card or ID.

✓

Patient contact info

Phone and home address.

Fast turnaround

We confirm referrals within 2 hours and schedule first visits within 24–48 hours of insurance verification.