Fortify-VidalMed Referral Portal

Once the form below is complete, you will automatically be redirected to VidalMed’s referral page to finalize your submission.

Before completing the form, we encourage you to make sure you and your client are prepared for the appointment, understand the purpose of the referral, and know what to expect going forward. If you haven’t already, please review the VidalMed Referral section in the Fortify Mentorship Hub.

Be sure to:

Discuss the annual physician fee and what it covers.
Explain that medication and lab costs are separate and may vary based on individual needs.
Clarify that affiliate access applies only while the client remains actively under your coaching care within the Fortify Mentorship.

If you have any questions or need help along the way, please reach out. We’re here to support you and your client.

Please Fill out the Form Below

Upon successful submission of your form, you will be automatically redirected to VidalMed’s referral webpage, where you will be required to complete a brief form to finalize your referral submission.

Referred by who? (YOUR name)

Referrer's Email (YOUR email)

Referred Client's Full Name (Name must match their Government ID)

Referred Client's DOB (MM/DD/YYYY)

Referred Client's Email Address

Referred Client's Preferred Phone Number (area code+ number)

I understand that using Fortify’s referral link to VidalMed is an extension of my professional role as a Fortify mentee. I agree to notify Fortify if this client’s coaching relationship ends, to ensure accurate records, protect client safety, and uphold the integrity of our professional partnership.

Form submission[]

Fortify-VidalMed Referral Portal

If you have any questions or need help along the way, please reach out. We’re here to support you and your client.

Please Fill out the Form Below

Join Our Free Trial