Welcome to the McDonald’s preferred vendor referral system, here you may create a referral that will be sent directly to the appropriate preferred vendor. Please note the required fields with an asterisk (*) as we need that information to process your referral expeditiously. Thank you for utilizing the preferred vendor referral system, we appreciate your business.

  • 1. Requestor

  • 2. Patient

  • MM slash DD slash YYYY
  • 3. Physician

  • 4. Claim

  • MM slash DD slash YYYY
  • 6. Billing

  • 6. Referral Type

  • 7. Instructions

  • Please fax your prescription for the requested services to 407-657-2344 to attention of the requested services. If you have an electronic document, you can attach it directly to this online order.
  • **If you have multiple attachments for this file, please mail them directly to our staff at [email protected]
    Max. file size: 50 MB.