Client Referral Form

How It Works

Fill out this simple form.
We'll reach out to your client within 1 business day to get them scheduled.
We'll keep you updated as treatment progresses. *

* Subject to client consent

Care Coordination

We will send you an update after each appointment or at your preferred cadence. *

  • Provider's name and contact information
  • Diagnosis
  • Medications prescribed
  • Side effects expected or experienced
  • Pharmacogenomics report (if relevant)
  • PHQ-9 and GAD-7 scores

* Subject to client consent

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

With client consent, we would also love to receive pertinent information from you about the client to provide better care.

Client Information

Provider Information


If you’re in emotional distress, text HOME to connect with a counselor immediately.


If you’re having a medical or mental health emergency, call 911 or go to your local ER.