Requesting Care

Submitting a referral for a patient, yourself,
or a loved one is easier than ever.

Contracting with health plans, we provide seriously ill individuals with an enhanced level of support, empowering those to stay in their homes with optimal well-being. 

Self and Patient Referral Portal


Referring you, someone you love, or a patient is easier than ever. Access the link below, and you will be directed to our secure referral form link. 

Get Started

PDF Referral Form


Download the PDF referral form and fax to 833-593-2739 or email securely to

Download Form

Still have questions regarding eligibility? A VyncaCare team member is ready to help. Call us at 1-888-227-8884


We have answers.