BridgePoint Accessibility
Thank you for referring your patient to BridgePoint Accessibility. This secure form is HIPAA‑compliant and encrypted through Hushmail. All information submitted is considered Protected Health Information (PHI) and will not be shared with anyone outside the care process. This form is designed to take under 2 minutes to complete. Once submitted, BridgePoint will contact the patient/family directly and handle all next steps.
Section 1: Provider Information
Section 2: Patient Information
Section 3: Reason for Referral
Section 4: Diagnosis/Relevant Medical Information
Section 5: Uploads
Section 6: Final Acknowledgement
Your information will be encrypted.
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