Refer a Patient

The Journey To Wellness Starts With You - Even for someone you know

Make a difference today. Complete the referral form by providing your information and your referral’s information. A member of Regional Psychiatry’s supportive care team will reach out to them discreetly, respecting their privacy and ensuring a comfortable, personalized experience.

Your Information

First name

Last name

Location

Phone Number

Relationship to the person you are referring to us

Patient’s Information

First name

Last name

Email Address

Phone number