Referral Portal | EA Physical Therapy

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Patient Referral Portal
Providers and Attorney's Only

First Name

Last Name

Email

Phone

Birthday * required

Law Firm or Physician Office

Patient Injury

Letter of Protection

Upload L.O.P

Upload supported file (Max 15MB)

Doctor or Physician Referral

Upload Doctor Referral

Upload supported file (Max 15MB)

Limited to Provider and Attorney's!

Submit Patient

frontdesk@elitealliancept.com

214-782-9167

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