Get Healthplex - Cape Fear Valley Health System

Completing the HealthPlex referral form online is a straightforward process designed to facilitate your access to fitness and wellness programs. This guide will walk you through each section of the form to ensure that you provide all necessary information accurately.

Follow the steps to fill out the referral form with ease.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient information. Provide the full name and date of birth in the specified format (m/d/y). This information is essential for identifying the individual referred.
3. In the diagnosis section, clearly indicate the diagnosis related to the referral. This could include any medical conditions affecting the user's ability to participate in fitness activities.
4. Next, outline any exercise limitations that may apply to the patient. Being thorough in this section will help tailor the recommended programs to meet the patient's needs.
5. Fill out the address section, ensuring you include the city, state, and zip code for accurate location details. Also, provide home and alternate phone numbers for contact purposes.
6. Identify the appropriate fitness and wellness programs. You can check all applicable options based on what services the patient may benefit from, such as general conditioning, massage therapy, stress management, etc.
7. In the risk identification section, please note any specific risks associated with the patient, as this information is crucial for the staff to understand their health requirements.
8. Add any additional comments that may assist in understanding the patient's needs further or any special considerations required.
9. Ensure that a physician’s signature is obtained, along with the date of signing, as this validates the referral.
10. After completing the form, review all entries for accuracy. Once confirmed, you can save changes, download, print, or share the form as required.

Begin completing your HealthPlex referral form online today and take a step towards better wellness.