Refer a patient

1Your information
2Confirmation

Clinicians may refer patients directly. Share a brief clinical summary and your patient's contact information, and a member of our team will reply to you. This form never emails your patient. Nothing reaches them automatically — a member of the study team decides whether and how to make contact, and does it by hand. Referral does not commit your patient and does not put them in a study. We do not take over their care.

Before you write: What to expect if you inquire · FAQ

Fields marked * are required.

About you — the referring clinician

First name *

Last name *

Credentials / role

Practice / organization

Email *

Phone

About your patient

Patient first name *

Patient last name *

Patient phone or email *

Study you are referring them for

Primary condition

Brief clinical summary (optional)

I have my patient's permission to share this. Referral does not commit them.

By submitting a referral you confirm that you have your patient’s permission to share their contact information with the ENACT research team. A referral does not enroll your patient in a study or commit them to participation.

Already sent a referral? Ask if we received it. Not sure a patient is in scope? Ask first, without naming them.

For clinicians

Not ready to refer? Three smaller forms, one question each.

The referral form above starts a referral. The links below don’t — each one answers a single narrow question, adds nothing to a patient’s file, and tells you exactly what happens next.

Prefer to reach us directly? Write to enact@enactresearch.com or call (203) 444-1795.

Refer a Patient.

Not ready to refer? Three smaller forms, one question each.

Is this the kind of patient I should refer?

Did you get my referral?

Email me when a study starts taking inquiries