Patient Referral Form

Thank you for choosing FAMh as your healthcare partner!

Your trust is highly valued, and we are eager to provide excellent care for your patients.

Our team will confirm the appointments with the patient(s) directly and keep your office informed upon request.

Please do not hesitate to reach out to us at your conveinece with any questions, comments, or any info needed.

Convenient ways to initaite a telepsychiatry appointment for your patient:

Form - Complete the easy to use form below.

1

Call - Talk to us on the phone at (877) 400-0540 & provide the information from the form below.

2