Healthcare Professionals

Your Ultimate Health Resource

Thank you for choosing to refer your patient to Western Drug! To start the referral process, please fill out the patient referral form below. If you have questions or need assistance, get in touch with our Customer Service team at 1-800-891-3663. Our goal is to help our customers and yours find the best home health solution for their lifestyle.

View Our Resources & Forms Below!

Click and download our documents and order forms listed below:

Contracted Health Plans & Managed Care Groups

Medicare-Medical Booklet

NPWT Order and Assessment Form

WD Equipment Order Form

Send a Patient Referral Order

Looking to refer a patient? Get started by filling out the patient referral form below. We look forward to providing the expert care our patients expect from us!

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Patient Information
Patient First Name
Patient Last Name
Patient DOB
Patient Height
Patient Weight
Patient Phone Number
Patient Emergency Phone Number
Patient Insurance Provider
Equipment Requested
Order Notes
Doctor Information
Doctor Full Name
Doctor Phone Number
Doctor NPI#

Your Ultimate Health Resource

View Our Resources & Forms Below!

Send a Patient Referral Order

Patient Information

Doctor Information