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Online Submission 
Please select the state of release

Instructions:
1. Select the state of incarceration
2. Enter details of incarceration to begin care intake. 
3. Already have prefilled forms? Email us at:

4851-8650-9813@mail.vault.netdocuments.com

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Member Services: 

1-833-PAT1ENT or 1-833-728-1368

 Fax:

1-844-927-5012

Email: 

contact@patientsortal.com

Hours:

Monday - Friday: 8am to 7pm

​Saturday & Sunday: Closed

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Patient Sortal is a registered mark of Patient Sortal Inc. © 2024 Patient Sortal Inc., All Rights Reserved.

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