Refer a Patient

Psychiatry Referral Form for Providers

We’re accepting new clients in: Alaska; Arizona; California; Connecticut; Washington, DC; Delaware; Florida; Georgia; Illinois; Indiana; Iowa; Kentucky; Louisiana; Maine; Maryland; Massachusetts; Michigan; Nevada; New Hampshire; New Jersey; New York; North Carolina; Ohio; Oregon; Pennsylvania; Rhode Island; South Carolina; Tennessee; Texas; Vermont; Virginia; Washington; and West Virginia.

We accept most major commercial insurance plans (excluding Medicaid) and private pay.

Lavender Psychiatry isn’t for everyone; learn more here about what we treat and prescribe.

Complete our HIPAA-compliant referral form, and we’ll gladly reach out to your patient, or give them our website, and they can complete our online self-triage process.

“I often refer patients to Lavender for combined therapy and medication support because I don’t have the capacity due to our restricted schedules. The referral process doesn’t get easier than this. I hand them a card and say, this place is great, and they love their clients.”

Paul Marquette
MD

Patient's first name *

Patient's last name *

Patient's location *

Patient's email address *

Patient's mobile phone *

Patient's date of birth (MM/DD/YYYY) *

Patient's insurance

Only in-network plans are shown. If your patient's insurance isn’t listed, we’re out-of-network, and payment is out-of-pocket. We can help with out-of-network reimbursement submissions.

Member ID

If you'd like your patient to see a specific psych NP at Lavender, please provide the psych NP's name

Reason for referral *

Psychotherapy

Medication management

Psychotherapy and medication management

Other

Please elaborate on patient care needs, if appropriate

Referring practice/provider name *

Referring practice/provider email *

Referring practice/provider phone *

How did you hear about us? *

If Other, please describe

Thank you for referring your client. We'll be in touch with them within 48 hours. If you have any questions or wish to connect with our Partnerships team, please email partnerships@joinlavender.com.

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