Access Our New Patient Referral Form

To begin the referral process CLICK on the "Download PDF" button below

REFERRAL - NEXT STEPS

Download our New Patient Referral Form

Fill out patient demographic

Fax over the following:

• Referral Form

• Last Doctor's Note

• Picture of Insurance Card

• Picture of ID (front & back)

• Any Recent Tests, Labs, or Procedures

FAX REFERRALS TO: 877-288-2067

*Once submitted, our credentialing and scheduling team will contact you to coordinate next steps.

Insurances We Work With

Alliance Mobile Medical Services, LLC

7300 State Hwy 121, Ste. 300 McKinney, TX 75070

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Phone: 682-532-6372

Website: AllianceMobileMedical.com

Email: info@alliancemms.com

"At Alliance Mobile Medical Services, we are dedicated to making healthcare more accessible and convenient for everyone. Our hybrid model of mobile and community-based services is designed to meet the evolving needs of our patients. Experience the future of health care with us - Our focus is to heal wounds, not just manage them." - Jeffrey Combs, CEO & Co-Founder