Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. In the 'Referring Physician' section, enter the name of the physician making the referral. Ensure that the information is accurate.
3. Fill in the 'Address' field with the complete address of the referring physician's practice.
4. Provide the 'Phone' number for the referring physician in the designated field.
5. If applicable, include the 'Fax' number where further documents or communications can be sent.
6. Date of Referral: Enter the date you are completing the referral. This is crucial for record-keeping.
7. In the 'Patient's Name' section, write the full name of the patient being referred for acupuncture treatment.
8. Fill out the 'Patient's Date of Birth' to verify the patient's identity.
9. In the 'Reason for Referral / Symptoms' area, clearly outline the reasons for the referral, as well as any symptoms the patient is experiencing that may be addressed through acupuncture.
10. The referring physician must sign the form in the 'Physician's Signature' section to authenticate the referral.
11. Select the appropriate option for the 'Progress Report' to indicate how you will follow up regarding the patient's condition.
12. Once you have completed all the sections, review the form for accuracy. You can then save the changes, download the form, print it, or share it as needed.

Complete your documents online today to ensure a smooth referral process.