Doctor Referral | La Mesa Rehab

Print a Referral Form for your Doctor

Physician Name

Physician Office Phone

Your Email (required)

Patient Name (required)

Date of Birth

Patient Phone

Select Insurance

Diagnosis

Does Patient Need Oxygen?
YesNo

Service Requested

Frequency/Duration: 2-3x Week for
12 Weeks10 WeeksOther

Precautions/Instructions:

Address:
8380 Center Drive, Suite E
La Mesa, CA 91942

Phone: (619) 466-6077
Fax: (619) 466-6118

Business Hours:
Mon-Fri – 9:00 am – 5:00 pm