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Patient ReferralRefer a patient, in a few minutes.
You do not need permission, a formal order, or a complete set of paperwork to start. Send what you have and we will take it from there.
Four simple steps. We handle the rest.
The form takes about five minutes. Documents come afterwards, on a separate secure link, so a missing facesheet is never a reason to delay a referral.
Tell us who you are
Provide your name, email address, and phone number so we know who submitted the referral and can contact you if we have any questions.
Tell us about the patient
Provide the person’s name, contact information, current location, and the type of support you believe they need.
Upload any documents
After you submit the referral, you’ll receive a secure link to upload a facesheet or any other supporting documents. No paperwork is required. Send whatever information you have.
We call you
Intake reviews the referral and contacts you, usually within one business day, to verify benefits and arrange an assessment.
Patient referral
Your details first, then the patient’s, then a secure upload link for any documents.
This form is hosted by Microsoft and your answers go directly to Mosaic Healthcare. If you would rather refer by phone, call (469) 757-1600 and we will take the details from you.
Anyone who sees the need
Referrals reach us from every direction, and none of them are wrong:
- Physicians and hospitalists
- Discharge planners and case managers
- Skilled nursing, rehab and assisted living facilities
- Social workers
- Families and caregivers
- Patients themselves
Send it anyway. We will tell you honestly.
If a patient is not right for us, we will say so and point you to who is. Nobody is left without an answer.