Referral Form

[av_slideshow_full size=’featured’ min_height=’0px’ stretch=” control_layout=’av-control-default’ src=” attachment=” attachment_size=” position=’top left’ repeat=’no-repeat’ attach=’scroll’ conditional_play=” animation=’slide’ transition_speed=” autoplay=’false’ interval=’5′ id=” custom_class=” av_uid=’av-kd4reude’]
[av_slide_full slide_type=’image’ id=’209′ video=’https://’ mobile_image=” fallback_link=’https://’ title=” video_format=” video_ratio=’16:9′ caption_pos=’caption_bottom’ custom_title_size=” av-medium-font-size-title=” av-small-font-size-title=” av-mini-font-size-title=” custom_content_size=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=” font_color=’custom’ custom_title=’#000000′ custom_content=’#000000′ heading_tag=” heading_class=” link_apply=” link=’lightbox’ link_target=” button_label=’Click me’ button_color=’light’ link1=’manually,http://’ link_target1=” button_label2=’Click me’ button_color2=’light’ link2=’manually,http://’ link_target2=” overlay_opacity=’0.5′ overlay_color=” overlay_pattern=” overlay_custom_pattern=” av_uid=’av-6m38d’][/av_slide_full]
[/av_slideshow_full]

[av_heading heading=’Thank You for Your Referral!’ tag=’h3′ link=” link_target=” style=” size=” subheading_active=” subheading_size=” margin=” padding=’10’ color=” custom_font=” custom_class=” id=” admin_preview_bg=” av-desktop-hide=” av-medium-hide=” av-small-hide=” av-mini-hide=” av-medium-font-size-title=” av-small-font-size-title=” av-mini-font-size-title=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=”][/av_heading]

[av_textblock size=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=” font_color=” color=” id=” custom_class=” av_uid=’av-kd4rf56e’ admin_preview_bg=”]

We look forward to taking great care of your patient. Thank you for the opportunity!

[/av_textblock]

[av_codeblock wrapper_element=” wrapper_element_attributes=” codeblock_type=” alb_description=” id=” custom_class=” av_uid=’av-keln99dx’]
[ninja_form id=5]
[/av_codeblock]

[av_textblock size=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=” font_color=” color=” id=” custom_class=” av_uid=’av-kelndh9p’ admin_preview_bg=”]

Please instruct patients to call (615) 814-0885 to schedule an appointment. New patients should arrive 15 minutes early to their scheduled appointment. Please provide any recent patient notes, MRI reports and/or pertinent medical information. We gladly accept most insurance plans.

[/av_textblock]

[av_button label=’Download Printable Referral Form ‘ icon_select=’no’ icon=’ue800′ font=’entypo-fontello’ link=’manually,https://ankleandfootcenterstn.com/wp-content/uploads/2021/02/Referral-FormTNFeb2021.pdf’ link_target=” size=’x-large’ position=’center’ label_display=” title_attr=” color=’theme-color’ custom_bg=’#444444′ custom_font=’#ffffff’ id=” custom_class=” av_uid=’av-kd4rfwmb’ admin_preview_bg=”]

[av_hr class=’default’ icon_select=’yes’ icon=’ue808′ position=’center’ shadow=’no-shadow’ height=’50’ custom_border=’av-border-thin’ custom_width=’50px’ custom_margin_top=’30px’ custom_margin_bottom=’30px’ custom_border_color=” custom_icon_color=” av-desktop-hide=” av-medium-hide=” av-small-hide=” av-mini-hide=” id=” custom_class=” av_uid=’av-bum5c’]

[av_heading heading=’Our Services’ tag=’h2′ link=” link_target=” style=’blockquote modern-quote modern-centered’ size=” subheading_active=” subheading_size=” margin=” padding=’10’ color=” custom_font=” custom_class=” id=” admin_preview_bg=” av-desktop-hide=” av-medium-hide=” av-small-hide=” av-mini-hide=” av-medium-font-size-title=” av-small-font-size-title=” av-mini-font-size-title=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=”][/av_heading]

[av_masonry_gallery ids=’171,112,174,173,114,113′ caption_elements=’title excerpt’ caption_styling=’overlay’ caption_display=’always’ size=’flex’ orientation=” gap=’large’ columns=’flexible’ av-medium-columns=” av-small-columns=” av-mini-columns=” items=’24’ paginate=’none’ color=” custom_bg=” overlay_fx=’active’ animation=’active’ container_links=’active’ id=” custom_class=” av_uid=’av-kelig95u’]

[av_hr class=’invisible’ icon_select=’yes’ icon=’ue808′ font=’entypo-fontello’ position=’center’ shadow=’no-shadow’ height=’50’ custom_border=’av-border-thin’ custom_width=’50px’ custom_margin_top=’30px’ custom_margin_bottom=’30px’ custom_border_color=” custom_icon_color=” id=” custom_class=” av_uid=’av-kd4v80q8′ admin_preview_bg=”]

Related Posts

Foot Corn Removal: A Comprehensive Guide

Foot Corn Removal: A Comprehensive Guide

Foot health is an often overlooked aspect of our overall well-being. However, anyone who has experienced the discomfort of a foot corn knows just...