For Medical Providers ONLY.
For ALL other referrals please use contact form on contact page!
FOR ASSISTANCE OR QUESTIONS PLEASE EMAIL: medical@betancurlegal.com
How we support providers:
✅ After You Refer a Patient
We Contact the Patient within 24 hours.
Case Intake & Agreement — we explain their rights and open the file.
Medical Coordination — we protect your lien with a Letter of Protection emailed or faxed to the contact information provided.
Ongoing Updates — you stay informed throughout treatment.
Settlement & Payment — patient recovers, and you get timely payment.
Simple. Fast. Professional.
Disclaimer: Submitting this referral form does not create an attorney-client relationship between Betancur Legal Group, PLLC, the provider, or the patient. An attorney-client relationship is only established once a signed agreement is executed directly with the client. All information submitted through this form is kept confidential and used solely for the purpose of evaluating potential representation. Providers must ensure they have the patient’s consent before sharing any personal or medical information. This form is not intended for emergencies. If the patient requires immediate medical or legal assistance, please call 911 or our office directly at 850-901-7647.
REFERRAL FORM
For Medical Providers.
A smooth process with minimal hassle.
How we support providers:
Direct communication with billing offices
Updates on patient case status
Aggressive lien protection & enforcement
No surprises—transparency every step
Education for patients on Florida’s 14-day rule