Refer a patient | Thriveworks

Would your patient benefit from high-quality mental health care?

On a mission to help people live happy and successful lives, we built our practice around our clients’ needs and personalize treatment to each individual.

Choose how you’d like to refer

Email your referral

partners@thriveworks.com

Submit a referral form

Go to form

Fax your referral

339-210-2101

Refer a patient to Thriveworks

Patient information
First Name*

Your first name is required
First
Last Name*

Your last name is required
Last Name
State*
Please select your state
Date of birth*

Please enter date of birth
MM slash DD slash YYYY

Please enter date of birth
Email*

Please enter a valid email address
Phone Number*
Please enter your phone number
Service requested
Reason for referral (optional)
Provider information
First Name*

Your first name is required
First
Last Name*

Your last name is required
Last
Provider NPI Number
Please enter your provider NPI number
Provider Email*

Please enter a valid email address
Phone number*
Please enter your phone number
Phone extension (optional)
Fax (optional)
Organization (optional)
Care Coordinator information (optional)
First Name

First
Last Name

First
Care/referral coordinator email

Please enter a valid email address
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By submitting this referral form, you are formally acknowledging that the information provided herein is, to the best of your knowledge, entirely accurate and provided with consent from the patient. You acknowledge that the information provided here is for referral purposes only, and no other Protected Health Information (PHI) is to be shared between you as the referring provider and Thriveworks Administrative Services, LLC, without proper written authorization from the patient.

Thriveworks strictly adheres to all applicable rules and regulations governing PHI, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA). To learn more, see our Notice of Privacy Practices.

Would your patient benefit from high-quality mental health care?

Email your referral

Submit a referral form

Fax your referral

Refer a patient to Thriveworks

Thriveworks

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