Welcome to the Garcia Family Medicine Referral Program

Thank you for participating! Please fill out this form to log your referral entry for our Spin-the-Wheel giveaway.

If you are at an affiliate business: Enter their Name in the form below.

If you are at Garcia Family Medicine: Confirm your referral to finalize your entry.

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Name

First Name

Last Name

Who Referred You?

Enter the name of the business that referred you.

By clicking "Submit to Enter!" and selecting "I agree," you confirm that you have read and agree to the Terms and Conditions of the Giveaway.

I agree.