Patient Referrals

Refer your patients to Prairie Health. Our experienced staff includes board-certified psychiatrists with same-week availability.

Provider Collaborations
1
Fill out the below online form or download and complete this faxable form.
2
We will reach out to your patient within 1 business day to get them scheduled.
3
We will keep you updated as treatment progresses. *
* Subject to patient consent
Provider Collaborations

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

1
Provider’s name and contact information.
2
Diagnosis
3
Medications prescribed
4
Side effects expected or experienced
5
Pharmacogenomics report (if relevant)
6
PHQ-9 and GAD-7 scores
* Subject to patient consent
Provider Collaborations

Download the referral form

Download this PDF form, then complete it and fax it to us. We will reach out to the patient and follow up with you directly. 

Download PDF Form

Already have a completed form?

Fax it to us at (650) 433-4428.

Patient Information

Provider Information


Provider Collaborations

Need more information?

If you have questions about our care program or would like materials to give your patients, check out our dedicated page.

Overview for referring providers

741-741

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

911

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