Maryland Living Well Center of Excellence

A Division of Maintaining Active Citizens

Provider Referrals

Refer your patients to one of our programs. These workshops will provide your patients with the skills and knowledge to better manage their chronic conditions. With their permission, a 3-month action plan and goal will be shared with you at the end of the workshop.

Option 1: Complete this referral form and submit it to LWCE by email. Once the form has been submitted, a program manager will contact your client or patient to discuss the self-management classes.

-OR-

Option 2: Fill out the online form and click Submit. LWCE will receive the form, and a copy will be sent to the email you provide.If you have provided the email of the patient, a copy of the referral will also be sent to them. 

Option 1: Referral Form

Refer your patients to one of our programs. Print and complete this referral form, and submit it to LWCE. Once the form has been submitted, a program manager will contact your client or patient to discuss the self-management classes.

Option 2: Online Form

Once you have completed the online form and clicked submit, LWCE will receive the form, and a copy will be sent to you and the patient if email addresses are provided.