Referral Form

To refer a patient to NuHope, please include a completed referral form, a copy of the patient’s demographics and insurance information, and the last clinical note.

Thank you for trusting NuHope in the care of your patient!

Once we have received the referral, we will verify the patient’s insurance and contact the patient to schedule. The referral can be faxed to (833) 211-4673.

If you are referring a patient for counseling services only (not medication management), please notate this on the referral form, so we properly book your patient for their first session