Refer a Patient

If you feel your patient could benefit from Telehealth Outpatient Mental Health Treatment, please complete the information below.

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Client Information

Referrer Information

By Submitting this form, I confirm that I have discussed Youme healthcare's services with the individual listed above and have their permission for Youme Healthcare to reach out to them, via electronic channels, and I understand that Youme Healthcare is a telehealth therapy provider.