Refer a patient to Waymark Care services
Thank you for your interest in referring a patient to Waymark Care. We are a free service that can help patients with Medicaid benefits access services such as support from a community health worker, behavioral health therapists and/or pharmacists. We will confirm a patient's eligibility for our services, and request a patient's consent before beginning service delivery. We will follow-up with you over the next a week to update you on your referral.

We safeguard the information that you provide via this form and store the data in an encrypted format. We do not sell your data or patient data. Information provided below is shared on a need-to-know basis for the purpose of determining your patient's eligibility for our services and, if your patient is eligible, facilitating your patient's treatment and care.

We will follow-up with you over the next a week to update you on your referral.
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Email *
Which state is your practice located in? *
Only states with current Waymark services are listed.
Primary care provider's first name *
Primary care provider's last name *
Primary care provider's phone number 
Numbers only, without spaces, parentheses or dashes.
Primary care provider's email address
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