Refer your patients, family members and friends to us and get a bonus! Please use the referral form below and put as much information as possible. For physicians and healthcare facilities, a downloadable Face to Face Encounter Documentation is available below that can be faxed to us at (703) 533-0312. Form – Referral Form non Comp Face To Face Encounter Form Disclaimer All medical information transmitted through this site, via email and fax are strictly confidential and protected by both State and Federal Law. It is unlawful for unauthorized persons to review, copy, disclose, or disseminate confidential medical information from and through BG Healthcare Services’ website. If in error, you receive information which you are not the intended recipient of, please notify us immediately through phone or email and delete the document immediately.