● For Healthcare Providers

Refer Your Patients to Reimagine Psychiatry

Partner with us to connect your patients with expert telehealth psychiatric care across California — fast, simple, and fully HIPAA compliant.

Step 1 of 3

Patient Information

Services are only provided to individuals 11 years or older at this time.

First Name * First name is required

Last Name * Last name is required

Date of Birth * Date of birth is required

Mobile Number * Mobile number is required

Email * A valid email is required

Reason for Referral / Additional Notes

Step 2 of 3

Select the patient's current insurance status below.

Patient has insurance Self-pay / No insurance Insurance information unavailable

Insurance Card

Uploading the patient's insurance card helps us verify coverage and coordinate care more efficiently.

Front of Card JPG, PNG or PDF

Back of Card JPG, PNG or PDF

Secondary Insurance

Does the patient have additional (secondary) insurance coverage?

Yes No