PATIENT + REFERRAL FORMS

Make the next step
simple.

Choose the patient’s regional referral form, then complete, download, print, and return it by fax.

Restoration mobile wound-care team

PROVIDER REFERRALS

Choose the patient’s
service area.

01RWC
North Idaho

Coeur d’Alene

Referral fax
877 376 4040

02RWC
Eastern Washington

Spokane

Referral fax
877 376 4040

03RWC
Treasure Valley

Boise

Referral fax
208 575 9937

NEED HELP?

We can walk you through it.

Call 208 449 1091 for Coeur d’Alene and Spokane, or 208 608 5378 for Boise and Meridian.