On-line Referral

Referrals for physical therapy, diagnostic testing, or wellness needs can always be faxed directly to (716) 285-1281 or given directly to your patient or athlete.  As a convenience, and to expedite the scheduling process across our five offices, we offer on-line scheduling for our partnering practices and facilities who want to utilize this option.  In order to ensure the best experience for the patient, please provide the following Patient and Referring information, along with any directions for treatment in the fields below.  If your patient or athlete is in severe pain, please select the next business day for scheduling.  We will contact, and schedule your patient within 24 hours and often on the same business day if requested.

If you have any questions while completing this form, or if we can help you in any way, please contact our front desk at (716) 282-2888 (Monday through Friday from 7:00AM-7:00PM).   Thank you for trusting Advanced Care Physical Therapy with your rehabilitative, diagnostics and wellness needs.

  • Patient Information

  • Referring Physician Information

  • Further Details

  • 7 + 7 =