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About Us - HealthSource Library Request subpage_title_arrow

Referring Providers
In order to send information via the postal service, we need the following information:
First Name:
Last Name:
Title:
Street Address:
City:
State:
Zip Code:
E-Mail:
Please provide your phone number in order for our volunteers to respond to your request, and should we need additional information in order to complete the request.

  Phone Number:
Please tell us the diagnosis of the patient in question so that we may better understand what information to send you:
Do you want information written for the lay person or for a medical professional?
 Lay Person  Medical Professional
Please help us respond to you and others in a timely manner by categorizing the urgency of your request:

 Emergent: need information mailed within a week.

 Informational: would like information when possible.


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