Online Referral Form

You may refer patients to our office by filling out our secure online Referral Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.

Technical Note: *Once reviewed, scroll down to submit your referral!

Mac Users

PC Users
Our online form uses the latest version of Adobe Acrobat Reader to conveniently submit the form from home or work. Please download the free plug-in from Adobe’s web site if it is not already installed on your system. It is important that you have at least version 9 of the plug-in to successfully use our online form.

Referring Dr. Form for Dr. T Lang

Please contact our office today to schedule a consultation!

Indian Harbour Beach Office Phone Number (321) 777-2166 Email Us

Our office is located at: 2030 South Patrick Drive #1, Indian Harbour Beach, FL. 32937

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  • Office Hours: Mon. – Thurs. 8:30 AM to 5:00 PM and Friday 8:30 AM to 1:00 PM.