For Clinicians

Refer a Patient

We will contact the patient directly to schedule an initial consultation, typically within five business days. We collaborate with referring clinicians throughout treatment to ensure continuity of care.

You may also fax referrals to (855) 452-6817 or send an encrypted email to referrals@bayareaneuropsychiatry.com.

Referring Clinician

Name *

Practice / Organization optional

Phone *

Email *

Patient Information

Full Name *

Date of Birth *

Phone *

Email optional

Insurance *

Referral Details

Urgency *

Routine

Urgent

Urgent referrals are triaged within two business days.

Reason for Referral *

Attach Records optional

Choose files or drag and drop

PDF, Word, JPEG, PNG, or TIFF. 10 MB maximum total.

This form is transmitted securely to our HIPAA-covered Google Workspace environment. No protected health information is stored in the browser. By submitting, you confirm you have obtained appropriate patient consent or authorization for this referral.