Five required fields. Nothing clinical, nothing you would not tell a receptionist over the phone.
If this is an emergency, do not use this form
Requests here are read during office hours only. If you are in crisis or worried about your safety right now, call or text 988 to reach the Suicide & Crisis Lifeline, available 24 hours a day, or call 911 if there is immediate danger. Connecticut residents can also call 211 for crisis and mobile crisis services.
What happens after you send it
No portal to set up, no forms to print. Three steps, and a person on the other end of each one.
Step 01
The office calls you
We confirm what you are looking for, answer questions about how the practice works, and check whether an evaluation is the right starting point.
Step 02
We check your benefits
Before anything is scheduled we verify your coverage and, where a service needs prior authorization, we file it. You get the cost in writing first.
Step 03
You are scheduled
You get a time, the address, and what to bring. If a service turns out not to be a fit, we say so and point you somewhere that is.
The office
10 Princeton St Ste N
Address10 Princeton St, Ste N, West Hartford, CT 06110
We accept referrals from psychiatrists, APRNs, primary care, therapists, and hospital discharge planners across Connecticut, and we report back to you.
Send with the referral
Patient name, date of birth, and a working phone number
Current diagnosis and the reason for referral
Medication history, including antidepressant trials with dose and duration, which is what a Spravato® prior authorization turns on
Insurance information, front and back of the card if you have it
Any relevant medical history, particularly blood pressure and cardiovascular issues
How to reach us
Use the form on this page and select "I am a referring provider", or contact the office directly.
Please send clinical records through fax or another secure channel, not through the web form.
Before you send it
Four things people ask the office most often when they call to book.
How soon will I hear back?
The office answers requests in the order they arrive and aims to reach you by phone. If you have not heard back within one business day, call so your request does not sit unanswered.
Do I need a referral to book?
No. You can request an appointment yourself. Some insurance plans require a referral for coverage, which is worth checking with your plan before the first visit.
What should I bring to the first appointment?
A photo ID, your insurance card, a list of the medications you take now, and the names of any antidepressants or other psychiatric medications you have tried before, with roughly how long you took them.
Can I request a specific clinician?
Yes. Put the name in the message field and the office will tell you what their availability looks like.
Ready when you are
Send the request and the office takes it from there. If you would rather talk to a person first, call.