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Refer a Patient to The Click Clinic

Refer a patient to receive physical therapy services.
 

We will reach out to your patient within one-two business days of receiving this form and get them booked for an evaluation as soon as possible. 

Please note that at present we are only able to provide care in the state of Georgia.

Patient Information

Date of Birth
Month
Day
Year
State

Address

Your Home

Phone

470-228-2334

Email

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