Fax Referral Information...

Referral Form

Referral Checklist

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This process uses an Adobe PDF form. Note that the information can not be saved on your computer unless you have Acrobat 7.0 Professional or later. You would need to print a copy for your records.

For users that have Adobe Acrobat 7.0 Professional
For users that have Adobe Reader 6.0 - 7.0

Please complete a referral form, print and fax to 772-220-5812.

All others, contact:
Sharon B. Griffin
1321 SE Riverside Drive
Stuart, Florida 34996-1286

Telephone: 772-219-9960 or toll free  866-967-4624
Fax: 772-220-5812
Email: askmai@medicareallocations.com