A Partner in Mental Health

Are you a University counselor, community provider, or triage specialist looking to refer a student to our services? Fill out our referral form below!

We take the guesswork out of mental health care referrals, with insurance-accessible care that treats the whole person — not just the diagnosis. We’re a trusted leader in mental health, and your partner in patient care.

Refer a Patient

Complete this form to refer a patient for mental health services. In-office and online appointments are available across California and Minnesota.

Mindpath College Health only accepts patients over the age of 18. If you would like to utilize Mindpath Health’s services (including child, adolescent, geriatrics, etc.), visit Mindpath.com.

Patient’s Name

Phone

Date of Birth

State

City or Preferred Office

Insurance Provider

Member Policy #

Group #

Is the patient aware that they are being referred for mental health care?

What type of service are you requesting?

Medication Management Therapy Couples/Partner Therapy Group Therapy

Reason for Referral

Referring Provider Name

Name of Practice/Group/Organization

Phone

Fax

Referral Upload (Optional)

Additional Questions or Comments

By clicking submit, you agree that Mindpath College Health may contact you by email, phone, or text.