Desai Health

Veterans Health Administration Referral: New Patient Intake

Veterans Health Administration Referral Clinic Intake Forms

To fully complete the online intake, complete the following forms by clicking the link below:

Veterans Health Administration Referral: New Patient Form

Complete this form if you want to allow our practice to disclose treatment or scheduling information with any other entity other than the patient/guardian:

Release of Information

If you have any questions or concerns about the intake process, please contact us at:

  • Email:
  • Phone:+1 (904) 638-8164 
  • Fax: +1 (704) 270-6207
  • Address: 8823 San Jose Blvd, Suite 301, Jacksonville, FL 32217
  • Administrative office hours Monday – Friday 9:00 – 5:00  (we are closed for lunch daily 12:00 – 1:00)

Still have questions?

We look forward to hearing from you and are happy to answer any questions you may have!
You may click the “Contact Us” button to email us directly or call the office at (904) 638-8164.