Refer a Patient

If you have a patient that you we can assist with information, support or financial assistance, please feel free to refer the patient to us.

Therapist Name*
Therapist Phone*
Therapist Address*
City, State, Zip*
Therapist E-mail*
How Can We Assist?*

(please be as thorough
as possible)
Patient Name*  
Contact Info
(phone or email

              *Full contact info is required to provide the info you request.

Verified by guidestar
Supported by grants from Susan G. Komen SW Florida
Information provided by Lymphedema Resources, Inc. is intended solely for education and should not be construed as medical advice or guidance which should always be obtained from a physician or other licensed healthcare professional.

Lymphedema Resources, Inc. is a 501(c)(3) Federal tax exempt public charity under the Internal Revenue Code. Donations to Lymphedema Resources, Inc. are tax deductible as allowed by law.

Copyright 2016 All Rights Reserved. Lymphedema Resources, Inc. PO Box 1115, Estero, Florida 33929 Site by Papyrus.