Referral form

Use the form below to refer someone who is covered by a Medicaid Waiver

(i.e. Home and Community Based Services)

This form is HIPAA Compliant. Call 952-562-1235 with any questions.

NPI# 1881253037
FAX: 844-999-1534

We will let you know the referral was received and then work to get the services approved and/or coordinate shipping and remote setup. When the device is shipped or notifications have been set up we will follow up with you again to let you know. Thank you for the referral!