Request For Service

You may submit a request for service using any of the following options:

Online Request Form


Send your request by email.

Fax / Postal

Read the instructions on how to print our referral form, then fax or mail it to us at:

Laurel Rehabilitation Services, Inc.
216 Haddon Avenue - Suite 702
Westmont, NJ 08108
Fax: (856) 869-7364

* Go directly to the printable form.


Speak to one of our friendly customer service representatives by calling (856) 869-7360