Skip to Search Skip to Content Go to Catalog

Send Us a Referral

Quick, Easy, and Secure

Sending a referral is quick, easy, and secure! We offer 5 easy options to choose from:

  • Online: Fill out our secure referral form at the bottom of this page. Then upload your patient's RxProgress Notes, and Face Sheet by clicking the "Choose File" button at the bottom of this page. Our online referral form is HIPAA compliant.
  • Fax: Fax your patient's Rx, Progress Notes, and Face Sheet to 510-799-9930.   A separate form is not required, but if you prefer to fill out a form to send along with your fax, you can download our DME Request/Referral Form click here
  • athenaHealth: If you are an enabled athenaHealth practice, you already have the ability to send us referrals through your athenaClinicals EHR. For instructions, view athenaHealth's Quick-Reference Guide or view athenaHealth's Demo Video.
  • eReferral: If you're interested in sending us electronic referrals through Parachute, GoScripts, Epic, Straticeor DMEhub, please email us at [email protected] and we'll get your office set up to start referring your patients to us through one of these ePrescribing platforms.
  • Phone: Call us at 510-799-9920 Monday - Friday / 8:30 am - 5 pm PST.

Referrals received before noon PST will be processed the same business day. Referrals received after 12 pm PST will be processed within 24 business hours. Once your referral is received, our Intake Coordinator will contact your patient to begin the intake process and coordinate an in-home evaluation if needed. Your referral is our highest priority and we thank you for choosing Freedom Mobility for your DME needs!

this is an image referral form

Online Referral Form

100% Secure & HIPPA Compliant

 Denotes a required field

  • File 1:

    File 2:
  • File 3:

    File 4:


  • hipaa logo