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SCHEDULE  A Study

Patheous Health can schedule an onsite swallow study service within 1 - 3 business days. Please select your market below and download the corresponding forms to get started. 

Northern Illinois, Michigan, Indiana, Wisconsin, Pennsylvania and Ohio

1. (Faxable) Patient Referral Form

Missouri, Kansas and Southern Illinois

(Patient Referral Form, Checklist and Authorization to Evaluate

2. Authorization to Evaluate

3. Day of Study Facility Checklist

North Carolina - Charlotte/Hickory, Winston-Salem 

1. (Faxable) Patient Referral Form

2. Authorization to Evaluate

3. Day of Study Facility Checklist

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