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Access the Donley Center Referral Form

 

We are pleased to offer you the added convenience of being able to access and send in the referral form while you are visiting our website. You can now fill in your patient referral information and email or fax it directly to us, all from the web page! Here are the step-by-step instructions:

  1. Click on the link: DonleyCenterReferralForm. You will be prompted to save this Word document into your own hard drive.
  2. If you wish to access the referral form for our new Aquatic Therapy for Acute Care/Low Back Injuries, click instead on the link: DonleyAcuteAquaticReferral and follow the same exact instructions as for the other referral form.
  3. Both windows are now open – you can easily click between the Referral Form Word document file and these instructions on our web page.
  4. Open the Referral Form document you have just saved.
  5. You can choose to
  • Print a hard copy of the blank form to hand-write your referral information in and fax it to us at 401-222-3887, or
  • Type your referral information directly into the form, print the hard copy and fax it to us at 401-222-3887, or
  • Type your referral information directly into the form, and then email it as a Word document file attachment
    • When typing in this Microsoft Word form, if you wish to check off a box, just double-click inside the box – a pop-up menu will appear; select “Checked” under “Default value” and then select OK – your response box will now be checked off in the form
    • After you are done typing, select from your top toolbar within the Word document: “File,” “Send;” a right-pointing arrow will appear, which you will click on, then select “Page By E-mail”/”Email as an Attachment” from the drop-down box. Type (or copy and paste) the email address: donleyscheduler@dlt.ri.gov and then select “Send”
    • Or you can click on the link: DonleyScheduler, attach your saved Word document and directly email it to us
  • From this point, you can select the “Back” button to return to the home page, visit other sections of the website, or exit the website after you are finished. If you have any questions, please call the Donley Center at 401-243-1200 and we will gladly assist you.


 
RI Department of Labor and Training
Dr. John E. Donley Rehabilitation Center
249 Blackstone Boulevard, Providence, RI 02906


Phone: (401) 243-1200
Fax (401) 222-3887
TTY via RI Relay: 711
1/15/14 MDF
State Seal
  DLT is an equal opportunity employer/program. Auxiliary aids and services available upon request