Referral form

Refer a Patient to Focus Point Psychiatric

Complete the form below to refer a patient for specialized mental health support and personalized care. Our team will reach out promptly to assess and coordinate their treatment plan.

Step 1 of 2

Referrer Information

Name *

First

Last

Email *

Age

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Referral Information

Address Age Name

Name *

First

Last

Email *

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Reseason for referral *

Frequently Asked Questions

1. Who can fill out the referral form?

Our referral form can be completed by healthcare providers, social workers, educators, or family members who want to refer a patient for mental health services at Focus Point Psychiatric.

2. How will Focus Point handle patient privacy in referrals?

Focus Point Psychiatric prioritizes patient confidentiality. All information shared through the referral form is kept secure and confidential, following HIPAA guidelines.

3. What happens after I submit a referral

Once submitted, our team will review the referral and reach out to the patient to discuss the next steps. We may contact the referrer if additional details are needed to ensure the best care.