S. Abbas Shobeiri, MD, FACOG, FACS
A Resource for Women's Pelvic Floor Disorders
S. Abbas Shobeiri, MD
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PHYSICAL THERAPY REFERRAL
The reason for referral:
The Name of referring Physician, the patient will not be seen without a referral.
First Name
Last Name
Address Line 1
Address Line 2
City
State
Zip Code
Daytime Phone
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Evening Phone
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E-mail Address
The modality ordered: manual therapy, electrical stimulation, evaluate and treat as indicated, etc.
Comments
IF YOU HAVE NOT RECIEVED A CONFIRMATION WITHIN TWO WORKING DAYS PLEASE CONTACT OUR OFFICE AT 405-271-9493
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