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Healthcare Providers

Refer a Patient

We make referrals simple. Choose the method that works best for your practice.

How to Refer

Four ways to refer

Online Form

Submit a structured referral online. Fastest method. Confirmation sent to your inbox immediately.

Submit Online Referral

Fax

Download our referral PDF, complete it, and fax to our secure HIPAA-compliant fax line.

Fax Number

(972) 942-9942

Phone

Speak directly with our referral coordinator.

Referral Line

(972) 942-9972

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Secure Email

Prefer email over forms? Enter your address and we'll send you a secure, HIPAA-compliant link you can reply to with referral details and any attachments.

Referral Checklist

What to include

Please include the following in your referral to expedite scheduling:

Patient demographics
Primary diagnosis / reason
Insurance information
Authorization number
Recent sleep-related labs
Current medication list
Urgency level
Your contact information
Insurance

Accepted plans

Search our full insurance list to verify your patient's coverage before referring.

View full insurance page →
Online Referral

Submit a referral

Fill out the form below. We'll contact you and the patient within one business day to confirm scheduling.

Referring Provider

By providing your phone number, you consent to receive text messages from ZYRA Sleep & Wellness. Standard message and data rates may apply. Reply STOP to opt out.

Patient Information

🔒 Referral information is transmitted securely and handled in accordance with HIPAA.