Refer patient

Refer a Patient or Request a Wheelchair Evaluation

Use this page to start the process. We’ll review your information, contact you, and walk you through next steps.

I’m a Hospital or Clinician

I’m a Patient or Family Member

If you’re a hospital, rehab, home health agency, SNF, or physician office, use this form to refer an adult patient in the Las Vegas area for complex power mobility or equipment review. We’ll confirm receipt and keep your team updated at key milestones.

Prefer to talk instead? Call us at 702-233-3770 between 9am to 5pm

If you’d rather fax documentation, you can fax it to: 702-233-3013

I’m a Hospital or Clinician

I’m a Patient or Family Member

Prefer to talk instead? Call us at 702-233-3770 between 9am to 5pm

If you’d rather fax documentation, you can fax it to: 702-233-3013

What happens after you send this?

You’ll see an on-screen confirmation that we received your request or referral.

Our team reviews the information to make sure we have enough to reach out and help.

We contact you (or your patient or caregiver) within 1-2 business days to discuss next steps and, if appropriate, schedule an evaluation.