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AgeWell Center serves Medicare-eligible adults, typically 65 years of age and older. If your patient is a current Medicare recipient and is suffering from one or more of the following geriatric syndromes, AgeWell may be a good fit.
In addition, if the patient has seen a downward change in status over the last 12 months (2 or more falls, emergency department and/or hospital visits), routinely takes over 10 medications (prescription and OTC), or has been diagnosed with multiple.
Fill out this appointment request form and we will call you to coordinate a date and time that works for you. All data you provide is encrypted to protect your privacy. If you would like to speak with someone during normal business hours, please call the AgeWell Center at 904.202.4243. If you’re a physician, make your referral here.
(*Indicates the information is required in order to submit your request.)
City, State Zip
Date of Birth:*
Who should we contact?*
Care Partner Name:*
Primary Phone Number:*
Secondary Phone Number:
Talk to one of our friendly coordinators to make an appointment.
If selecting one of these services, please also submit a physician order.