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


    Thyroid dysfunction

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

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


    *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.