This virtual clinic is not a crisis service or substitute for an emergency room, and cannot coordinate ER visits, psychiatric hospitalization or law enforcement intervention.

Thank you for filling out this form for your patient to the best of your ability. Please note that we will be able to process the referral sooner with more information. At a minimum, you will need your patient’s name, phone number and insurance details.

Please note that every time you click "next page," the data you enter automatically saves and is visible to our scheduling staff. If you would like your referral and patient data deleted, please call call us at 855-520-2291. We will only call to schedule your patient after you click the "submit" button on the final page.

We currently accept these insurance plans (click "accepted insurance plans"). Please note that this list changes often.

As with any referral for medical care, insurance coverage will be verified according to UW Medicine standards. Please advise your clients that just like any other medical service, they should review the coverage provisions of their specific healthcare plan, including but not limited to potential out of pocket expenses and health insurance network provider requirements.

If you have any questions/concerns, feel free to give us a call at 855-520-2291.

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*This platform is HIPAA-compliant

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