Refer a Patient

Collaborating to instill hope in patients.

If you’re considering referring a patient but uncertain about their suitability, entrust that decision to us! We’ll assess your patient to determine their eligibility for TMS and keep you updated throughout the process.

Patient Referral Form

Patient First Name

Patient Last Name

Patient Email

Patient Phone

Patient Date of Birth

Patient Zip Code

Patient Primary Diagnosis

I'm referring my patient for:

TMS Therapy I'd like a provider to asses which treatment is right for my patient

Referring Provider Name

Referring Provider Phone Number

Referring Provider Email

Referring Provider Specialty

Referring Provider Practice Location

Refer a Patient

Collaborating to instill hope in patients.

Patient Referral Form

Your life is important, it's time to start living it!

Please contact us if you are in need of psychiatry, counseling, coaching, or consulting services.

we want to hear from you