Refer A Patient

We are honored that you would like to refer a patient to one of our providers! We highly value collaborating with referring providers to optimize patient care. We would like to make this process as simple and safe as possible.

Here are a couple of options:

1) Contact the Raleigh Psychology provider directly via email or phone. See “Contact” button above.

2) Fax relevant information and patient records to a Raleigh Psychology provider at (919) 322 - 3800.

3) Complete the form below with PROVIDER’S information, so that a Raleigh Psychology provider can get in touch with you as soon as possible.

REFERRAL TO RALEIGH PSYCHOLOGY PROVIDER (FROM ANOTHER PROVIDER)

Name

Provider

First Name

Last Name

Referral Type (Counseling or Assessment)

Best Times to Contact Provider

Presenting Problem (NO Identifying patient information, please)