For Providers

Refer a patient

Use this form to refer a patient to Thymos Health if they have been diagnosed with autoimmune disorder(s) or if autoimmunity is suspected.

After receiving your referral, our team verifies eligibility and contacts the patient directly to complete enrollment and better understand their needs.

We'll notify your team once they're enrolled or if we have any questions. For questions or referral updates, contact us at referrals@thymoshealth.com.

Referring Provider

Tell us how to reach you and where you practice.

Full name

Practice / organization name

Practice phone

Practice fax (optional)

Patient Information

Basic contact details so our team can reach the patient directly.

Individual's First Name

Individual's Last Name

Date of birth

Phone number

Preferred language (optional)

Address line 1

Address line 2 (optional)

City

State

Zip code

State of residence

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