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This form is for 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 or use the fax number above the button. 

Thank you for referring to Teras!  

Referral Form