Referral form

We would love to work together for your patients. Please fill out the form below for any patients you’d like to refer and we will reach out to them or send us an email/ call us directly. Thanks!

Option 1: Email/ Call with the Referral

Feel free to call our office directly at (210) 446-9918‬

Open 7 days a week from 9 AM to 8 pm ET

Please email contact@adgcares.com with the following information:

Your name, practice name, and phone number
Guardian’s name and phone number
(Optional) Patient’s name and phone number

Option 2: Fill out the form below

Provider Name

First Name

Last Name

Provider Specialty

Email

Guardian Name

First Name

Last Name

Phone

(###)

###

####

Patient Name

First Name

Last Name

How did you hear about us?

(Optional) Please provide any additional information that would be helpful.