Provider Resources
If you have a provider who is interested in volunteering with Project Access please have them complete the Physician/Dentist Volunteer Form (Microsoft Word document, 46 KB). Once completed, please forward the form along with a copy of the provider's license to Project Access, attention Kate Ellmann.
If you have a patient being seen at your office that you feel would be eligible for services through Project Access, please complete the Patient Referral Form (Microsoft Word document, 245 KB) and fax it to Project Access (344-8770), attention Michele.
If you have a patient who is already enrolled in Project Access but is being referred to a specialist, please complete the Specialist Referral Form (Microsoft Word document, 245 KB) and fax it to Project Access (344-8770), attention Michele.
If you have any questions concerning provider participation, patient eligibility or referrals please call Project Access at 344-4200.
Additional Forms:
Notification Form (Microsoft Word document, 27 KB)
Patient Eligibility Form (Microsoft Word document, 33 KB) |
