Refer your Patients

We are an extension of your team

Please fill out this easy form so that we can start taking care of your patients. Our Bilingual Concierge Care Guides will contact your patient and you to make the process fast and easy. And we will keep you informed so that when the patient comes back, you can continue to take care of them and their health.

You may also fill out our Referral Form and fax it to the number in the form:

Your Information (as Referral Coordinator):

Your Patient Information:

Reason for Referral: (Surgery and/or Study)

Cirugía Care (Surgery Care) is a product of Fully Alive Health , a Christian healthcare savings platform. Our Concierge Cirugia Care Guides work hard to remove any fears, hassles, worries of the patient surgical journey so our members can focus on healing. We provide access to our network of board-certified expert and compassionate surgeons, hospitals, physicians, diagnostic services and patient lifestyle education programs at a low cost, high quality, personalized and transparent care that the people of God deserve.

© Fully Alive Health

Cirugia Care - Consultation Referral Form
File Size:	692 kb
File Type:	pdf

Entrust us to take care of your Patients

Referral form