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Patient Referral Form PDF

Fax form to: 412-276-9033

Email: referrals@tma-wpma.com

Only Medical Professionals can fill in the form.

Come in and watch a procedure

If you are a medical professional, you can give us a call to schedule a time to come in and watch a procedure for Your CEU Credits or just to see a procedure. 

Pretty cool right?

Call us at: 412-276-9030

or fill out the form below

Patient Referral Form Fillable PDF 

Fax form to: 412-276-9033

Email: referrals@tma-wpma.com

Only Medical Professionals can fill in the form.

Required Patient Documents

Fax form to: 412-276-9033

Email: referrals@tma-wpma.com

Only Medical Professionals can fill in the form.

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