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Refer Your Patient for Psychiatric Services 
At PsychLink, we take pride in making referrals from physician and therapist offices easy.  Simply fill out the form below and we will contact the family to set up an initial evaluation.  We do ask that you inform the family that you are making a referral for our services, so they will be expecting our call.  If you want us to inform your office when the initial appointment has been scheduled, please enter your contact information.  If you have any questions, feel free to call us at 615.596.5494 or send an email to referrals@psych-link.com .

Patient's First Name:
 *
Patient's Last Name:
 *
Patient's DOB:
Parent/Guardian Name:
 *
Home Phone:
Cell Phone:
Patient's Insurance Provider:
 *
Name of person making referral:
 *
Contact Number:
 *
Email address:
 *
Do you want us to inform you when we schedule an appointment:?
How do you prefer for us to inform you of an established appointment?
Referring Provider's Name:
 *
Practice Name:
 *
Practice/Office Address:
 *
Practice/Office Phone Number:
 *
Practice/Office Fax Number:
 *
Reason for Referral:
 *
Current Medications or Medical Conditions (if known):
Additional Comments:
Do not enter anything in this field:
* indicates a required field


PsychLink: Nashville Psychiatric Nurse Practitioner Consortium, LLC


Phone: 615.815.1772

Email:  hope@psych-link.com


Office Locations:
1901 B Logue Road h Mt. Juliet, Tennessee h Wilson County
638 Hartsville Pike h Gallatin, Tennessee h  Sumner County


Mailing/Billing Address:
1901 B Logue Road
Mt. Juliet, Tennessee 37122