Mental Health Provider Referral Form

Please read our referral criteria. This form is for Primary Care Providers and Psychotherapists. This is not a guarantee of treatment.

Referring Provider’s Name:(Required)

Provider’s Phone:(Required)

Extension:

Provider Fax:

Organization:(Required)

Patient Name:(Required)

Patient Gender/Pronouns:(Required)

Patient DOB:(Required)

Patient Email:(Required)

Patient Phone:(Required)

Patient Address:(Required)

Patient Insurance Company:(Required)

Contact Name (if different from patient):

Contact Relation:

Reason for Referral:(Required)

Please list all of the patient's mental health diagnoses:(Required)

Has this patient been hospitalized for psychiatric reasons or attempted suicide within the last 3 months?(Required)

Has this patient been diagnosed with an eating disorder or substance use disorder? Please list name of disorder and current status:(Required)

How long have you been working with this individual and how often do they see you? Have your appointments been in-office, via telehealth, or a combination?(Required)

Patient’s most recent vital signs (height, weight, BP/pulse) and date/setting taken:

Please include any clinically relevant information regarding this patient (or fax most recent encounter note to (503) 386-3293:

Thank you for taking the time to coordinate care for this patient. We will email the patient to let them know we received your referral.

Skycloud Admin

Let's Find a Path Forward Together

It’s not about what you’re struggling with. It’s about knowing you have a partner that is here to work with you and help you feel better. At Skycloud Health, we meet you where you are and walk with you at your pace.

Understanding the Referral Process

The referral process at Skycloud Health is designed to ensure that patients receive the most appropriate mental health care tailored to their needs. Primary care providers and psychotherapists play a crucial role in this process by submitting detailed referrals that include patient history and specific treatment needs.

To facilitate a smooth referral, it is essential for referring providers to review the referral criteria carefully. This not only helps in determining the suitability of the patient for the services offered but also ensures that the information provided is comprehensive, which can significantly enhance the chances of timely and effective care.

Insurance and Payment Options

Skycloud Health accepts a variety of insurance plans to make mental health services accessible to a broader audience. Understanding the insurance coverage can help patients and their providers navigate the financial aspects of treatment more effectively.

Patients are encouraged to verify their insurance plans before scheduling an appointment. This can be done by contacting the billing department directly. Options include major providers like Aetna, Cigna, and Medicaid, among others, ensuring that a wide range of patients can access necessary mental health services.

Patient Eligibility Criteria

To ensure that Skycloud Health can provide the best possible care, certain eligibility criteria must be met by potential patients. This includes age restrictions and specific mental health conditions that the practice is equipped to handle.

For instance, Skycloud Health does not see clients under the age of 13, and specific conditions may require additional documentation or assessment. Understanding these criteria can help referring providers guide patients more effectively and avoid unnecessary delays in treatment.

Telehealth Services Overview

Skycloud Health offers telehealth services to enhance accessibility for patients who may face challenges attending in-person appointments. This service is particularly beneficial for individuals in remote areas or those with mobility issues.

Through telehealth, patients can receive psychiatric evaluations and psychotherapy from the comfort of their homes. This flexibility not only reduces travel time but also allows for more consistent follow-up care, which is essential for effective mental health treatment.

Understanding the Referral Process

The referral process at Skycloud Health is designed to ensure that patients receive the most appropriate mental health care tailored to their needs. Primary care providers and psychotherapists play a crucial role in this process by submitting detailed referrals that include patient history and specific treatment needs.

To facilitate a smooth referral, it is essential for referring providers to review the referral criteria carefully. This not only helps in determining the suitability of the patient for the services offered but also ensures that the information provided is comprehensive, which can significantly enhance the chances of timely and effective care.

Insurance and Payment Options

Skycloud Health accepts a variety of insurance plans to make mental health services accessible to a broader audience. Understanding the insurance coverage can help patients and their providers navigate the financial aspects of treatment more effectively.

Patients are encouraged to verify their insurance plans before scheduling an appointment. This can be done by contacting the billing department directly. Options include major providers like Aetna, Cigna, and Medicaid, among others, ensuring that a wide range of patients can access necessary mental health services.

Patient Eligibility Criteria

To ensure that Skycloud Health can provide the best possible care, certain eligibility criteria must be met by potential patients. This includes age restrictions and specific mental health conditions that the practice is equipped to handle.

For instance, Skycloud Health does not see clients under the age of 13, and specific conditions may require additional documentation or assessment. Understanding these criteria can help referring providers guide patients more effectively and avoid unnecessary delays in treatment.

Telehealth Services Overview

Skycloud Health offers telehealth services to enhance accessibility for patients who may face challenges attending in-person appointments. This service is particularly beneficial for individuals in remote areas or those with mobility issues.

Through telehealth, patients can receive psychiatric evaluations and psychotherapy from the comfort of their homes. This flexibility not only reduces travel time but also allows for more consistent follow-up care, which is essential for effective mental health treatment.