Refer A Patient

ViveWell Health welcomes the opportunity to partner with practitioners in patient care.

We prioritize the special relationship you have with your patient. Our team can provide as little or as much support as you want… let us know how we can be of assistance. Thanks for partnering with ViveWell Health to provide the best patient care possible.

Refer a patient to ViveWell Health

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Patient name*

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Patient email*

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Patient phone*

Brief history, diagnosis, reason for consultation and/or services desired*

Patient notified of referral?*

Yes

File

Please upload any relevant lab or imaging results, consultation reports, etc.

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Max. file size: 200 MB.

Referring provider information

Referring provider name*

First Last

Referring provider email*

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Referring provider phone*

Department or specialty

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Disclaimer: All statements and opinions provided are for educational and informational purposes, not for medical diagnosis. As with all medical treatments and procedures, results may vary on an individual basis. ViveWell follows all FDA guidelines related to the treatments provided. You’re encouraged to consult with your primary care provider before undergoing any treatment programs offered by ViveWell. Some of our therapies are not FDA-approved. During your personal consultation, the benefits and risks of any recommended therapies will be reviewed with you.

Refer A Patient

ViveWell Health welcomes the opportunity to partner with practitioners in patient care.

Refer a patient to ViveWell Health

Referring provider information

Done referring?

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