Refer A Patient — EZ Psychiatry

Skip to Content

Clinic Policies

Initial Screening

No Show/Cancellation Policy

Refer A Patient

Clinic Policies

Initial Screening

No Show/Cancellation Policy

Refer A Patient

Folder: Clinic Policies

Initial Screening

No Show/Cancellation Policy

Refer A Patient

Let’s work together.

We love to collaborate with physicians, therapists, coaches, group facilitators, massage therapists, and anyone else who may be part of a patient’s care team.

Name of Referring Provider *

First Name

Last Name

Role *

Physician/Primary Care Provider

Therapist

Coach

Other

Email *

Patient Name *

First Name

Last Name

Patient Email *

Patient Phone

(###)

###

####

Patient Location *

New York

New Jersey

Reason for Referral *

ADHD

Anxiety

Burnout

Depression

Life transitions

Metabolic Health/Weight Management

Mood Disorders

Women's Mental Health

Medication Evaluation

Psychosis

Grief/Bereavement

Other

Seeking Second Opinion

Anything else you'd like us to know?

Thank you! Patients may also reach out to us directly through the Contact form.

Questions?

Phone: 646.598.3441 * Fax: 260.344.6310

Fees & Payment Refer A Patient