Referral from Virtue Consultant

Referral for Remote Managed Care or Membership

Open to all patients

To make a Referral, please complete the following Referral Form.

Or call us on 0121 816 0425

Lines are open between the hours of 09:00 - 18:00 Monday - Friday, excluding Bank Holidays.

Details of the Referring Clinician & Patient

Name and title of the Referrer

First Name

Last Name

Name of Patient being Referred

First Name

Last Name

Please confirm you have patient consent to share their personal information (if applicable)

I confirm that I have patient consent to share their information

Phone number of Patient

(###)

###

####

Email address of Patient

What is the primary condition the Patient has?

What are you referring the Patient for?

Please add any further narrative to describe the objectives of the monitoring

What period of Remote Managed Care do you consider most appropriate for the patient?

Refer into our Urgent Acute Virtual Ward

Open on 5th November

What happens after submitting the Referral Form?

Following receipt our your Referral form a Member of our Client Services Team will contact the Patient and the Referrer (if this option has been selected) to understand the treatment objectives and to explain the Remote Monitoring Plan options and pricing.

Once we have understood the requirements we will provide the Patient with a Service Schedule and explain our Terms of Business, which can also be found here on our website. To support the Patient in considering the services, we will send a copy of the Service Schedule and Terms of Business to them and arrange a follow-up call, should they wish.

Once the Patient is ready to proceed, we will make record of their Consent, take payment and then onboard them onto the service.

The end-to-end process can be done within a matter of minutes, or at a slower pace should the Patient wish to have time to reflect on the decision and discuss with family members of the Referring clinician.

Clinical Referral

From a Virtue Consultant