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.

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*

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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