Thank you for your interest in receiving referrals from AASL.
On occasion, our team of speech and occupational therapists has the need to refer out a patient to your specialty and in order to make sure we send the you the patients you can treat we need a little more information please.
We would like to build a referral profile on your needs and protocols of your practice regarding referrals. To ensure we are following your protocol in this matter, we need some basic information from you. To facilitate this, please complete this form. If you, your assistant, or office manager could please take a moment to fill out the form, it would be greatly appreciated.
Danielle Raccomandato, our Patient Care Coordinator, may contact your office to follow-up on the information you have sent back to us.
Please call should you have questions regarding one of your patients, speech and/or occupational therapy in general, or our practice in particular. We look forward to hearing back from you or possibly meeting with you in the near future.
Patient Care Coordinator
Phone: (813) 616-4004