Local: (204) 956-6777 | Toll Free: 1-888-722-5222
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Local: (204) 956-6777 | Toll Free: 1-888-722-5222

Refer a Patient

Working closely with healthcare professionals to ensure a fast and easy referral process

We provide home/hospital visits to educate patients about the advantages of Victoria Lifeline’s medical alert systems, ensuring peace of mind and understanding of our services.

If you would like Victoria Lifeline to contact your patient:

(with their permission)

You can either refer online by filling out the fields below or by calling our office directly at (204) 956-6777 or toll-free at 1-888-722-5222.

Fill out the Victoria Lifeline Referral Form to fax to our office – Fax # (204) 261-7719 or toll-free 1-877-784-6865

Referrals are processed quickly and our Education Facilitator will let you know the outcome of the referral.

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Name

Subscriber Information

Name
Address
Does the patient or caregiver approve to be contacted?
Who should we contact?
Fill out if caregiver should be contacted
Type of Referral Request
Receive Updates?