To become a patient at our clinic we will need a referral completed by your current psychiatrist and a copy of your last visit clinic notes. This must be an MD or a DO physician. We can NOT accept referrals from ANY other mental health care providers incl. MHNP, therapists or psychologists.
We will require that the referral be renewed on a monthly basis by your psychiatrist.
Below is a link to a blank referral form as a PDF.
If you need a psychiatrist please see the list below.
Ready to become a new patient? Fill out this easy and secure form!
Medical Intake Form
Authorization to Release Medical Information Form
Psychiatric Referral Form
Would you like more information?