Refer a Patient

earn $60 referral fee for each patient who signs up

Please press the 'Refer A Patient' below to bring up a form. Please complete the form to refer a patient to Lucid Lane (previously known as Breaking Benzo). Our Health Coach will contact the patient immediately to complete the in-take. Our in-house MD will then build a personalized tapering plan.

Please note: This form contains information that is confidential and privileged and will be treated as such by Lucid Lane. All information submitted in this form is encrypted and meets HIPAA compliance standards when submitting this form electronically.