eReferral

Make a Referral

We're looking forward to working with you.

Make your referral your own way.

1. Request a blank form to complete and FAX or Email back.
2. Make a Telephonic Referral at (888) 736-7636.
3. Complete & Submit an Online Referral Form below.
The referral process will begin with a telephonic consultation to review specific goals, timelines, and special service instructions. Please plan to spend at least 5-10 minutes with your SeeingU team at the onset of each referral.

Referral Client Information

Patient Details

Referral:
Type:

Supporting Documentation

You may upload up to three pdf files.
   

National Telemedicine Biopsychosocial Treatment Resources​

Join Our Network of Preferred Providers

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