VBOT Patient Referral
Refer your patient to VBOT quickly and easily.
Where is the referral coming from?
Self
Family Member or Friend
Treatment Center
Division of Social Services (DSS)
Emergency Department
Primary Care Provider
Other/Manually Enter NPI
Lookup Facility/Provider:
Referral Source Contact Name
Referral Source Contact Phone
Referral Source Contact Email
Provider/Facility NPI:
Patient Mobile #:
Patient First Name
Patient Last Name
Is the patient currently with you?
Begin Enrollment
© 2024
© 2024