Refer a Patient

For referring providers. Submit a secure referral for psychiatric care, TMS, or Spravato treatment. Our team will contact you and the patient within one business day.

Treatment

General psychiatric evaluation, medication management, and ongoing care.

Patient

First name *Last name *

Date of birth Phone

Insurance

Insurance provider

Member ID Group #

Insurance card (optional)

Front

Back

Referring provider

Your name *NPI

Practice / clinic

Phone Email *

Clinical

Primary diagnosis Prior treatments Clinical notes

Medical records (optional)

Drop PDFs or images here, or click to browse

Progress notes, evaluations, imaging, or lab reports

Attach progress notes, prior evaluations, imaging, or lab reports. PDF, PNG, JPG, or WEBP — up to 8 files, 20 MB each. Uploads are stored securely and only visible to our clinical staff.

Treatment timing

Interested in starting (month)

Timing notes

Helps our coordinator plan the intake or authorization timeline.

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