Patient Referral — Swap Health

Make a Patient Referral

Partner with our registered dietitians to get your patients nutrition care — covered by most major insurance plans.

Patient Information

First Name * Required

Last Name * Required

Mobile Phone * Required

Email * Please enter a valid email

Date of Birth *

Insurance * Required

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Providing DOB and insurance information streamlines intake and makes it 2× as likely your patient begins care quickly.

Member ID * Required

Group Number (optional)

State * Required

Conditions (optional)

ICD-10 Diagnosis Code (optional)

⚠️ Medicare patients require a diagnosis of Diabetes or Chronic Kidney Disease for insurance coverage.

Patient Notes (optional)

Provider Name * Required

NPI Number (optional)

Practice Name (optional)

Provider Phone * Required

Provider Email (optional)

🔒 Transmitted securely and stored in Swap Health's private records system.

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Thank you — our team will follow up with your patient within one business day.

Questions? Email us at support@swaphealth.com