For physician offices and DME suppliers

Refer a patient

Send a patient to Respirago for home respiratory care, CPAP/BiPAP setup and adherence, oxygen support, and telerespiratory follow-up. A licensed respiratory therapist will call your office, usually within one business day.

Urgent or discharge-ready? Please call (682) 337-3253 as well. For an emergency, call 911.
Sending clinical documents: This form is sent by email, which is not fully private, so it asks only for the basics needed to open a referral. Please do not enter Social Security numbers, member IDs or detailed notes. Call us for our secure way to receive the signed order, face-to-face note, and clinical records.

About your office

About the patient

Referral

Services needed (check all that apply)