Send a referral to Orbis Vascular
For dialysis center staff. Attach the referral and answer what it does not already say.
1. Your dialysis center
Choose your center…
My center is not listed
Your name *
Your direct phone *
Your email
2. Patient and referral
Patient last name *
Patient first name *
Date of birth *
Referral
*
Drag the file here, or tap to choose
PDF, or photos of each page (JPG / PNG). Up to 20 MB each.
Insurance card (optional)
Drag the file here, or tap to choose
Front and back, if you have it.
I am sending this referral for this patient's care at Orbis Vascular, and the information is correct to the best of my knowledge.
Send referral
Sent securely to Orbis Vascular. This page cannot show any patient information.