Refer a Patient

We make it easy to refer a patient:

Open the appropriate referral form

  • Fill in the patient details

  • Save to your computer

  • Have the medical provider sign the referral form

  • Fax all supporting documentation to Vital Care of Crown Point. Our Fax Number is219-600-1800 – See the provider resources for all documentation needed to obtain prior authorization

*If you have a question about a medication not listed, please use the General Medication Referral Form.

Referral Forms