Patient Referral Portal
Complete the form below to submit your referral.
By submitting this referral, you are formally acknowledging that the information provided herein is, to the best of your knowledge, entirely accurate. Additionally, you represent yourself as a healthcare provider or representative of a healthcare entity legally authorized to treat the aforementioned patient. Furthermore, you are requesting the dissemination of any patient health information from Thrive Telepsych to you or the entity you represent, solely for the purpose of providing future care to the referred patient.
