For providers

Refer a patient to V-Care

Send us a referral for primary care, chronic disease management, in-house diagnostics or an exam. We’ll contact your patient and confirm with your office.

Referring provider

Provider name *

Practice or facility *

NPI

Phone *

Fax

Patient

First name *

Last name *

Date of birth *

Patient phone *

Patient’s insurance *

Patient’s preferred language

Referral

Service requested *

How soon should the patient be seen? *

RoutineWithin a weekWithin 48 hours

Reason for referral *

0/1500

Referral documentsChoose a file or take a photoJPG, PNG, HEIC or PDF · up to 10 MB

Notes, recent results or an order, if you have them.

The patient has agreed to this referral. *

Fields marked * are required.

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