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AGENCY REFERRAL

This form is for providers and other agency referrals only. Please do not use this form if you are the client.

INSTRUCTIONS: STEP 1-Please submit the form below to refer your agency's client to Teras. 

STEP 2-Use the myfax button to the right to upload and fax digital documents (pdf's) securely to Teras. THE MYFAX BUTTON ONLY ACCEPTS ONE PDF document per submission.If you have multiple documents that can't be consolidated into one-use the fax number above the button 503-715-5672 and send through your fax machine. 

Thank you for referring to Teras!  

Referral Form