For hospitals, physicians, and partners

Make a professional referral.

Begin a responsive transition-of-care conversation with Gentle Care. Do not transmit protected health information through this general website form.

Professional referral request

Complete the brief form below. Your email app will open with the information ready to send securely to Gentle Care.

Your name *Title or role *Organization *Direct phone number *Professional email *Referral source *Patient/client initials only *Service county or city *Requested follow-up *General referral note

Please do not enter diagnoses, Social Security numbers, insurance numbers, financial details, or other sensitive medical information. Call 334-239-7462 if private details must be discussed.

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