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Provider Referral Form

We appreciate your referrals and commit to reach out to your patient within 24hrs. We accept most insurances and will verify coverage with the patient. Cash pay and Medicaid discounts are also offered.

Patient charts can be faxed to 910-408-7441 if needed.

Thank you! 

Patient Information

Lactating Parent is considered the patient. 
We appreciate multi-disciplinary care- our patients deserve it! 
Our contacts-




910- 408-7441


Thanks for submitting!

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