Completing this form will ensure we have all the proper information to get in touch with the patient and communicate with you as well.
Additionally, please attach all relevant medical notes and history including: patient demographics and
insurance information, current history and physical, list of current medications, dressings, wound
care etc., recent lab results, radiology reports, EKG, vascular studies, implantable devices
Please Select The “Download Form” button and print it. Once completed, you can return here and upload it from your computer or Email / Fax it to us!
Fax it to : (817) 337-6866
Or Email it to us: friscoInfo@r3healing.com
WOUND CARE AND HYPERBARIC OXYGEN THERAPY
Located in The Dallas-Fort WORTH, Houston and San Antonio Areas of Texas
