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Refer a Patient

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Providers:
Refer Your Patients to Psynoptic for the Psychiatric Care They Deserve

High-quality psychiatric care with a swift turnaround, ensuring the timely and exceptional support they deserve.

Helping your patients receive exceptional psychiatric care has never been easier. 

  • Complete the form below to refer a patient (takes 3-5 minutes).

  • We will contact the patient with an invitation to take our online assessment.

  • Once reviewed, an appointment can be scheduled within days.

  • If requested, we can arrange provider to provider contact.

Patient Referral

Patient's Gender
Patient's Date of Birth
Month
Day
Year
What conditions has the patient been diagnosed with? Select all that apply.
Has the patient been hospitalized for any psychiatric or mental health reason in the previous twelve (12) months?
No
Yes
Has the patient had suicidal thoughts in the last six (6) months?
No
Yes
I do not know
Has the patient engaged in self-harm or other self-injurious behaviors in the last six (6) months?
No
Yes
I do not know
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