Make a Referral | Aveno Healthcare

Make a referral

For discharge planners, social workers, case managers, physicians, SNFs, and rehabilitation centers. Prefer to call? Reach our team at (740) 590-5867.

Before you start

What we need

Only routing information — enough for our team to reach you and understand the request.

Patient name and county
Service requested and urgency
Your name, role, and organization
How to reach you for follow-up

Please do not include diagnoses, medication lists, or clinical records here. A secure, HIPAA-compliant process is used once our team follows up.

This form collects only what’s needed to start a conversation. Please do not enter diagnoses, medication lists, or other detailed health information here. A secure, HIPAA-compliant intake process is used once our team follows up.

Patient

Patient first name*

Patient last name*

County*

Service requested*

Urgency*

Referral source

Your name*

Organization

Your role*

Phone*

Email*

Preferred contact method for follow-up*

Notes (optional)

Non-clinical context only — e.g. discharge date, family contact, scheduling constraints.

I confirm I'm authorized to make this referral and that Aveno Healthcare may contact me using the details above.

Refer a patient to Aveno.

What we need