P3 Health Referral Request

Home / P3 Health Referral Request

    Please Select a Doctor:

    *Referrals for Dr. Cook must come from a physician or nurse practitioner.*

    Referring Physician/ Nurse Practitioner

    Patient Information

    Reason for referral:


    Assessment and treatment of Lyme disease, MSIDS (Multiple Systems Infectious Disease Syndrome), Chronic Fatigue Syndrome/ Myalgic Encephalitis (ME), Exertional Intolerance Syndrome (EIS)



    Preventive Medicine



    Bioidentical Hormones


    Assessment and treatment of parasite


    Mold toxicity


    Heavy metal toxicity


    Fibromyalgia/Chronic Pain Syndrome


    Cognitive (decline and mental health)


    Autoimmune Thyroid dysfunction


    Cancer


    Thyroid dysfunction


    Microbiome Dysfunction/ Small Intestinal Bacterial Overgrowth (SIBO)/ Irritable Bowel Syndrome (IBS)

    Please include a brief history of the patient’s symptoms:

    Labs

    *please fax to 1.855.921.1887

    Previous blood and urine results


    Previous diagnostic imaging reports


    Public Health – Lyme


    Public Health – Lyme Co-infections


    Medication List


    Supplement List

    Please allow 2 weeks for a confirmed appointment date.
    Thank you.