Make A Referral | Health Connect America

Our online referral portal is a secured, HIPAA compliant system that will let you submit a referral online to the regional Health Connect America office you’ve selected. Items with an asterisk are required.

Before submitting your referral to us, you will have a chance to review it at the very end. The referral will be securely sent to the office in question. A friendly Health Connect team member in the office you’ve chosen will follow up with you.

If you are having difficulty using the online form or have any questions on how it works or its security, submit a website inquiry on our Contact Us page. A member of our team will follow up with you regarding your question.

If you prefer to fax your referral, click below to create a PDF referral.