Refer a Patient—For physicians
What is required for a complete referral to CMC’s pulmonary rehabilitation program?
Where can I find the physician clearance form to sign?
Click here to download a referral form
- Physician referral / Physician clearance form
- Pulmonary Diagnosis
- Most recent H&P and other pertinent medical information
- Recent EKG within 6 months
- Recent PFT within 2 years
, please sign and fax to: 603.665.2449.
You can call also call: 603.665.2545
and the Pulmonary Fitness team will facilitate. Make sure to check the last two boxes for cardiac clearance,