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Referral Form

Referral Form Download

Referring to RBA Therapy is simple!

1) Download and print our referral form by clicking on the link below.

2) Ask you physician to complete the referral form

3) Send the referral form to RBA via email ( or fax (614)-863-9338

If you need assistance, just call our office (614)868-1115 or email us ( We can complete the referral form for you and send it in to your physician!