Refer your patient to AndHealth

We love partnering with providers around the community! Refer your patient for care with AndHealth. We offer convenient access to patient-centered care for all patients, including those on Medicaid and Medicare. New patients are seen in under 2 weeks with urgent and next-day appointments available.

Appointment requests can be made through this online form, via fax, or by calling our patient onboarding line.

Contact

614-526-4551

[email protected]

"*" indicates required fields

Patient information

Patient name*

Patient date of birth*

Patient phone number*

Patient email (optional)

Specialty services requested*

Dermatology

Rheumatology

Neurology

Diagnosis or suspected diagnosis*

Reason for referral*

Referral urgency*

Urgent (1-3 days)

Next available (1-2 weeks)

Additional important notes (optional)

Referring provider details

Physician name*

Physician phone number*

Physician NPI*

Practice name*

RHEUMATOLOGY

DERMATOLOGY

NEUROLOGY

INFECTIOUS DISEASE

Refer your patient to AndHealth

Patient information

Referring provider details