Provider Referral
Referral Information for Healthcare Professionals
This referral form is for use by licensed medical and mental health professionals submitting patients for psychiatric consultation or evaluation.
Please fax all relevant and current medical records to +1 (646) 585-4187.
Patients should not use this form. Patients may visit the Contact Us page for administrative inquiries or to reach our team regarding appointments.
Note: This form is reviewed by administrative staff and is not monitored by clinicians in real time. Patient information submitted through this referral form is handled securely and in accordance with privacy standards.
Do not include urgent or time-sensitive clinical information.