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Referral Form

VIA Health Partners

951 Wendover Heights Drive

Shelby, NC 28150

Tel: 704.487.4677  |  Fax: 704.481.8050

View all office locations here.

If you are referring yourself, a family member, or a loved one, please complete the form below. For privacy reasons, we ask that you do not include ANY personal health information in your form submission.

If you would like immediate assistance, please call us at 704.487.4677. Thank you for considering VIA Health Partners. During normal business hours, we will respond to your inquiry within four hours or less. For referrals after normal business hours and on weekends, please call 704.487.4677.

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Thank you for your message. We look forward to responding to you shortly.

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