Refer a Patient for comprehensive care for depression and anxiety

How it works:

  1. Fill out this simple form.

  2. We'll reach out to your patient to get them scheduled.

  3. We'll keep you updated as your patient’s treatment progresses*.

    * subject to patient consent

Coordinated communication:

We’ll send you a fax or email after their first appointment followed by quarterly updates*.

* subject to patient consent

  • Provider's name and contact information

  • Diagnosis

  • Treatment plan

  • Medications prescribed

  • PHQ-9 and GAD-7 score

We’ll also let you know if for any reason we weren’t able to reach your patient or needed to refer them elsewhere.

Patient Info

Optional, if Phone is provided
Optional, if Email is provided



Optional, Patient must be an adult

Provider Info



Referring Patient For

Select one or both

Internal Note (optional)