If you are unable to upload supporting documentation, you can submit the referral form by selecting "Submit" below and you can fax supporting documentation (Face sheet, Lab information, and Clinical information) to Pentec at 1-800-355-1029.
Electronic Referral Portal © 2024 Pentec Health - All rights reserved.
I noticed that you haven't attached any files for this referral.
Would you like to Fax addtional documents to Pentec Health?
Please fax your documents to
The file you are attempting to attach isn't allowed. The following file types are available for upload...