Physical Therapy Memphis TN

Referring Provider Form

Below is a link to Momentum’s Referral Form (Prescription) that may be completed and submitted online. It will come directly to our office – no need for faxing.

Physician Referral Form

As you’re completing the form, you’ll also have the opportunity to upload the patient’s demographics, insurance information, medical history and other needed documentation. Please be assured that all the data submitted here is secure and the process is compliant with HIPAA privacy standards.