Patient Referral Form for Providers

Streamline Therapy Referrals with Our Provider-Patient Form

Partnering with healthcare providers to deliver smooth, efficient, and collaborative mental health care for your patients.

At Nurture Therapy, we understand the importance of smooth and efficient referrals between healthcare providers. Our user-friendly referral form simplifies the process of connecting your patients to our specialized therapy and psychiatric medication management services.

SUBMIT A PATIENT REFERRAL

We believe healthy, supported individuals raise healthy, happy families.

In-Network Coverage

Blue Cross Blue Shield

(PPO & Choice)

Aetna

UnitedHealthcare (IL)

UMR (IL)

USHIP & UCHP

(University of Chicago Plans)

Convenient, Secure & Collaborative Patient Handoffs

Designed to save your practice administrative time while getting your patients scheduled quickly.

Convenient & Efficient

Simple digital submission form that eliminates administrative friction for your practice.

Secure & Confidential:

Fully HIPAA-compliant portal protecting patient privacy at every step.

Collaborative & Comprehensive

We work alongside referring healthcare providers to support well-rounded, continuous care.

Timely & Fast Scheduled Appointments

Our team promptly reviews incoming submissions and follows up quickly to get your patient scheduled.

SUBMIT A PATIENT REFERRAL

Take The First Step Today

Connect with our intake team for a complimentary 15-minute consultation.

How To Submit a Referral

1. Fill in the required fields with your patient’s information and your contact details.

2. Include any relevant clinical notes or attachments.

3. Click submit, and our team will promptly review and follow up on the referral.

100% confidential.
In-network with major insurance plans.
Typical response within 1 business day.

Questions? Give Us a Call

If you prefer, you are welcome to call or text our intake team directly at

(773) 234-9948

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For the woman that tries, time and again,

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A Mindful Moment

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Relationships, Therapy

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