Assigning patients

Simple, safe and medically coordinated

Assignment form

Assign patients directly to ViaSlim. Use our referral form for a direct submission. We offer individual, evidence-based advice for sustainable medical and personal success.

Assignment form

Please fill out the form completely.
All information is kept confidential and used exclusively for medical care.

Information about the referring professional/practice

01/03

Patient personal information

02/03

Medical information about the patient

03/03

Submit
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