Refer A Patient

Please complete the following form to initiate your referral.

Once submitted, we will begin processing the request
and will reach out to your patient within 2 business days.

Patient First Name

Patient Last Name

Patient Date of Birth

Patient Phone Number

Patient Email Address

Referral Notes (optional)

Referring Office Name

Referring Office Contact Person

Referring Office - Phone Number

Referring Office - Email Address

Elessar Psychiatry requires patient email addresses as a part of our referral process, as new patients will receive a secure link (via email) to complete the necessary intake evaluation prior to scheduling an appointment.

If you wish to submit a referral but do not have your patient’s email address on record, please call, text or email our referrals team directly for assistance.

Request a Consultation

This consultation option is for primary care providers and other medical specialists who are managing their own psychiatric patients and would like consultation from Katy Alderman.

Katy has 10 years of experience in Mental Health Integration and Collaborative Care and enjoys providing chart reviews and brief phone consultations with healthcare providers.