Community Agency Provider Referral Form

This referral form is for Fletcher Allen's community partners that have worked with our Community Health Team (CHT) and have a client that might benefit from the services of the CHT. The Community Health Team will inform the client’s primary care provider and we will let you know how we will proceed.

If you have questions, please contact us at (802) 847-1601.

Please download and fill out the form and return it via email to cht@vtmednet.org or send via fax or postal mail to:

Community Health Team
Fletcher Allen Health Care
128 Lakeside Ave, Suite 106
Burlington, VT 05401

Phone: (802) 847-1601
Fax: (802) 847-6545

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