738 Old Norcross Rd, suite 100. Lawrenceville, Georgia 30046

Referral Request

Please complete and submit the following form and one of PAL's office staff will respond to your inquiry as soon as possible.

 Fields marked with an asterisk (*) are required. All other fields are optional.

Referral Request From PAL


For Medicaid referrals, please provide the doctor's reference number:

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