Please follow these steps to submit the form via Fax
Electronic Referral Portal © 2020 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?
Thank you for your referral to Pentec Health
Would you like to print a copy and fax with the referring physician's signature and signed prescription to 484-480-2252?
Please fax your documents to
The selected file isn't allowed. Please use one of the following file types.