Physician's Referral & Orders

Please complete and submit the referral form below for your patient.


Referring physician's offices may now upload orders and relevant patient records when making web referrals.

Click the UPLOAD button at the bottom of the form to send orders and records.

Contact:

High Thrive Therapy LLC

75 Bishop Street, Ste. 19

Portland, ME 04103

207-808-8382

contact@highthrivetherapy.com

Patient Referral Form - Web Submission

icon dk blue transp.png

Occupational Therapy Referral Form
High Thrive Therapy 

Provider Information
Patient Information
Medical Notes: Check any that apply. Please give special instructions, if necessary.
Presenting Concerns:
Evaluate And Treat As Indicated:
UPLOAD Patient Records:
Choose File