Professionally printed and customized for each provider.
Use the order form to have more referral pads delivered.

Size:  5.5” x 4”

Use: Given to a patient if both provider and patient agree COZI is a good fit for them.

Customization: Each provider’s unique referral code, regional COZI coordinator’s contact information, and specific instructions for the patient to follow up with their doctor if they end up not to be eligible for COZI (optional).