New York-Presbyterian / Weill Cornell Psychiatry

Patient Referral Portal

Referrer information

Your first name*

Your last name*

Your title/role

NYP/WCM clinic

Your phone

Your email

Patient information

Patient's first name*

Patient's last name*

Patient's date of birth*

Patient's phone number*

Patient's email

Patient's State

Patient's Zip Code

Patient's insurance provider:

Patient's member ID:

What is the patient's preferred service delivery method

Virtual

In-person

No preference

Which level of care are you recommending for the patient?*

Therapy & counseling

Psychiatric care

Intensive outpatient programming (IOP)

Substance or alcohol use treatment

Undecided

Clinical documentation (as applicable):

Drop files here or

Max. file size: 5 MB, Max. files: 5.

Please include any current medications, psychiatric history, most recent clinical note, and PHQ9, GAD7 or any other available behavioral health screening inputs.

Tell us a little more about the patient and their current needs

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