Refer A Client

Refer A Client

Refer your patients, family members and friends to BG Healthcare Services. 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.

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.

Below are the required forms (Click to view/print forms and fax it back to (703) 533-0312)