ReferralFlow Central

Submit a Referral

Fast and trackable referral intake.

We Proudly Accept

Medicare

Community Health Choice

Integranet

Molina Medicare

BCBS Medicare

United Health Care Choice

Aetna Medicare

United Health Care MMP

Wellcare Texan Plus

Wellcare Medical

UHC Medicare

United Medicare Advantage

Wellmed-Wellpoint Medicaid

Wellpoint Medicare

Wellpoint MMP

Other

Phone: 713-378-0781

Email: office@centraloftexas.com

Fax: 713-378-5289

How can we contact you about this referral?

Organization / Facility Name

Contact Name

Phone Number

Email Address (for confirmation)

Patient Information

Patient Full Name

Date of Birth

Patient Full Address

Patient ZIP Code

Insurance Information

Primary Insurance Payer *

Services & Diagnosis

Additional Patient / Order Notes

Supporting Documentation

Referral Documents

Progress Notes

I will be faxing information to 713-378-5289 (Office is notified to expect fax)

Uploading documents allows us to confirm insurance and respond faster. You can additionally fax it to 713-378-5289. Max total size: 5MB.