VitalFamilia Referral Request

Referring Provider/Case Manager Name

First NameLast Name

Organization/Practice

Referring Professional Type

Provider Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Provider Email Address

example@example.com

Preferred Language

Patient Name

First NameLast Name

Patient DOB

MonthDayYear

Patient Contact

Phone NumberEmail

Best Time to Reach Patient

Select All That Apply

Please share any additional information that would help us better understand the patient's needs.

Consent Confirmation

Would you like a follow-up from VitalFamila

WHAT HAPPENS NEXT?

Within 1 business day, VitalFamilia will contact the patient or authorized representative to discuss services, answer questions, and determine whether out concierge nursing support is a good fit.

With patient consent, we may communicate significant concerns or barriers back to the referring provider.

VitalFamilia is a private-pay concierge nursing service. Patients receive detailed invoices that may be submitted to their HSA/FSA administrator for potential reimbursement based on individual plan eligibility.

VitalFamilia Nurse Concierge
Serving El Paso Families
Phone: (915) 247-8344
Direct referrals and provider collaboration are welcome.