Professional Referral

Several options to complete referrals to Better Life Partners:

  • Complete the form below

  • Call, text or fax us:

    • NH: 603-563-0837

    • VT: 802-478-0597

    • Toll-free: 1-866-679-0831

    • Fax: 802-332-3117

Please complete the form below

Patient Name *
Patient Name
Date of Birth *
Date of Birth
Primary Phone Number *
Primary Phone Number
Contact *
Patient consents to text/message *
Referring Phone Number *
Referring Phone Number