Patient Portal Access

Referring Physicians

Please complete the referral form below in its entirety and return to us with relevant medical records including a complete medication list.   You will recieve a call back from our office within 24 hours.  You can fax the information to 570/348-1109 Attn:  Donna.
New Patient Referral FormPlease print and complete the form in its entirety. Fax the information to 570-348-1109 Attn: Donna.

Copyright HealthBanks, Inc. All rights reserved. | Terms of Use | Privacy Policy