Dr. David Blair
Center for Health Psychology, Inc.

 

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Physicians & Providers Resources


Patient Referral Form

Choose format
(same form in either format):

PDF *(23kb)
MS Word
(22kb)

Please fax this form to (three zero four) 342-8311,
with a copy of the pertinent MEDICAL RECORDS and an ENLARGED copy of the patient's insurance card(s) (front and back, please). Thanks!

Please feel free to contact us with any questions or suggestions:

Phone: (three zero four) 342-8300

E-mail - click here

 

 



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C. David Blair, PhD, Licensed Psychologist, Charleston WV

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