VBOT Patient Referral
Refer your patient to VBOT quickly and easily.
Where is the referral coming from?
Self
Family Member or Friend
Division of Social Services (DSS)
Emergency Department/EMS
Peer Program
Post-Overdose Response Team (PORT)
Primary Care Provider
Treatment Center
Other
Manually Enter My 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