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PHYSICAL THERAPY REFERRAL FORM PHYSICIAN INFORMATION: Referring Physician Phone: PATIENT INFORMATION: Patient Name: Phone: Date of Birth: Secondary Phone: MEDICAL INFORMATION: Circle Condition: ACUTE
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How to Fill out Physician Information - UMFlint:

01
Access the UMFlint website and login to your student account using your username and password.
02
Navigate to the "Student Services" section and click on "Health Services" or "Medical Services".
03
Look for the "Physician Information" section and click on it.
04
Fill out the required fields with accurate and up-to-date information about your physician.
05
Provide the physician's full name, contact information, and specialty if applicable.
06
Make sure to double-check the accuracy of the information before submitting the form.

Who Needs Physician Information - UMFlint:

01
Students at UMFlint who require medical treatment or have ongoing medical conditions need to provide physician information.
02
This information is necessary for the university to have on file in case of emergencies or to assist with any medical needs during your time at UMFlint.
03
It allows the university's Health Services department to coordinate care, communicate with your physician, or refer you to specialized medical treatment if necessary.
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