Caregiver Support Referral

Together, we're ensuring family caregivers get the support they need. Nolia Health provides insurance-covered therapy, training, education, and support groups through telehealth, helping caregivers navigate chronic conditions with greater confidence. By referring to Nolia, you're connecting caregivers to compassionate support that reduces stress and improves quality of life for caregivers and the people they care for.

Referred by:

*Name

Organization

*Who are you referring to Nolia?

Your selection appears first below; both sections are always shown.

Individual with a chronic conditionThe person living with the chronic condition.Care partner / caregiverSomeone supporting a person with a chronic condition — e.g. a family member who needs counseling, navigation, or support groups and ACCESS.

Primary referral — Individual living with chronic condition

Optional, but helpful.

*Name

State of residence

Select State

Is the patient living with a chronic condition?

YesNo

Chronic Condition Details

0 characters entered · 191 remaining

Sent to Monday as the Chronic Condition value. If left blank, we send “Yes.”

Insurance

We check with insurance carriers to ensure you're in-network with us. If you have questions, reach out.

Additional context — Primary care partner

Optional if the individual you are referring does not have a care partner.

Name

Relationship to individual

Contact info

Required — best number to reach the referred individual or their care partner.

*Best contact number

Additional Information

Additional Notes

*Verbal consent for referral to Nolia Health obtained from patient or authorized representative.Please check this box if you want to proceed.

Questions about a referral?

(855) 621-0466 hello@noliahealth.com

Support for family caregivers, covered by insurance.