Provider Portal & Referrals

Personalized, Ongoing Support for Those Who Want More.

Refer A Patient To Evigilant Care

We welcome referrals from physicians, therapists, hospitals, treatment programs, and other healthcare professionals.
Evigilant Care provides physician-led medication management for chronic conditions, complex medication regimens, opioid use disorder, outpatient benzodiazepine tapering, and medical weight management.
 
Submit the secure referral form below. Our team will review the information and contact the patient or referring office within 2-3 business days. Submission of a referral does not guarantee acceptance into treatment.
Referral Form

Provider Information:

Fill out this section with provider details


Patient Information:

Fill out this section with patient information


Referral Details

Fill out the referral information