A hospital case manager and/or social worker can submit a patient referral Monday-Friday 8AM-4PM and Saturday 11AM-5PM. We accept clients 8AM-6PM, seven days a week. Complete the form below and upload face sheet, H&P and a list of current medication.

Contact National Health Foundation at (866) 643-7284 with any patient referral questions.

Referring Organization Information
Patient Eligibility Check