Referral Forms

Refer Patients to Virginia at Home Program

• Make a Referral to VaH Program (for providers only)
• If you are not a provider, please contact populationhealth@virginia.edu

Refer Patients/Clients to Short-Term Behavioral Health Services (Population Health Department)*

• Make a Behavioral Health Referral (for providers only)
• Make a Behavioral Health Referral - VaH Program (for VaH providers only)
• Request a Behavioral Health Appointment - (self-referral only)

*Eligibility: The following individuals are eligible for Behavioral Health Services through Population Health Department:

• UVA Patients recently discharged from UVA-Health after a hospitalization and referred to our patient programs
• UVA Fellows, Residents, Staff, Faculty, Clinicians, and Clinical Team Members (including UPG & UVA-Wise)
• Please note: Individuals that we support must reside in the state of Virginia at the time of service.