Make a Referral to Empowered Endings
Our Medical Group is happy to receive referrals from healthcare providers and other community partners. Please take a moment to complete the referral forms so we have the information we’ll need to follow up appropriately.
In accordance with HIPAA regulations, our referral form has two steps: the first regards information about the referral source; the second is a HIPAA-protected form to facilitate our connection with and understanding of the patient/client’s needs.
If you have any difficulty, or wish to provide more specifics about the referral, please complete the form and feel free to call us at 858-925-7554 or send a secure email to email@example.com.
Thank you for trusting the Empowered Endings team to become part of your village of support!
Step 1: Referring Party Information
Please complete Step 1 by filling out the information request below and continue to Step 2 to provide information regarding the patient/client.