If you are having trouble submitting your self referral follow the instructions below for the topic that most closely describes your issue. ​

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The referral won’t let me submit or click continue 

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All boxes must be completed before the referral will allow you to submit.

In the top right corner of the referral form, there is a button titled “List of Fields”. If you click on it, it will give you a checklist of boxes with green check marks indicating which fields are complete. You can scroll down the list to ensure that you have filled out every field. Any field with a grey circle beside it is incomplete. You can click on the gray box in the list of fields to have the form bring you directly to the empty box.  

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My referral disappeared as I was filling it out 

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Check your email to see if you received a notification from us.

Our office isn’t able to offer certain services such as Court Ordered care, Short- or Long-Term Disability, FMLA paperwork or treatment to patients younger than 15, or older than 75. If one of these services were selected, our form automatically sends you an email to save you the time of filling out the rest of the form. If you clicked it by accident, feel free to re-submit your referral, and we will be happy to process it for you.  

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If this is not the case, double check your internet connection, as there may have been a brief loss of connection that caused the form to disappear.

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I cannot upload my insurance card

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If you’re having trouble uploading your insurance card, scroll down past the “Upload an Image” section for the front and back of your card. Just beneath the second orange upload button, there is a checkbox that reads “Having trouble uploading your insurance? Click Here.” and you can select “Upload Card Later”, then text the pictures of the front and back of your insurance card to 864-520-2020. 

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The form is blank when I select it on your website

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The form is blank when I select it on your website.  

If the form is blank, it may not be supported on your device or browser. There are a few things you can try.  

1. Open an Incognito Tab and try to fill the form out that way. Sometimes pop-up blockers, or virus protections may block the form, so opening an Incognito Tab will fix this.  

2. Open a different browser such as Google Chrome, or Microsoft Edge if you have other browsers available on your device. 

3. Try filling the form out on a difference device, or a friend / family member’s device. 

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I’m not sure if my referral submitted

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You will automatically receive an email copy of your referral within one hour of submitting it. If you receive this email copy, rest assured that we have received your referral! If you do not receive this email within 15 minutes of submitting, please let our office know the time you submitted it so we can try to recover the referral.