Step-By-Step Patient Referrals

Complete Simple Referral Form

Fax Relevant Records

Consider Our Referral Resources

(optional)

Medical Personnel Referrals

Referral Form

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Complete Referral Form

Place a HIPAA compliant referral here if you have a pediatric patient in California experiencing symptoms of ongoing abdominal pain/IBS, headaches, or other health-related concerns.

Please note: At this time, we are able to provide care in English only.

Referral Form

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Please arrange for documentation to be faxed to Streamind at 855-234-9106

Fax Relevant Records

Documentation should include:

Referring Provider’s Last Note:

At a minimum, we require the most recent note from the referring provider.

Relevant Medical Documentation

Any additional medical records that pertain to the reason for the referral or the presenting problem are highly valuable and will support the referral process.

Insurance Reimbursement

Please include any relevant insurance information, if possible.

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Consider Our Referral Resources

How to Introduce Streamind to Patients

This handout provides clear, practical guidance for discussing Streamind with your patients, including suggestions for how to introduce, educate, and prescribe CBT for their condition.

Intro to CBT for Headache

Share with families to introduce our headache program, why CBT is effective for headache management, how our model works, and what they can expect.

Document

Intro to CBT for DGBI

Share with families to introduce our DGBI program, why CBT is effective for GI symptoms, how our model works, and what they can expect.

Document

Common Family Q&A

Share with families to address common questions and hesitations about starting condition-specific behavioral health care.

Document

Provider

Handout

Patient

Handouts

Looking for a dotphrase to accompany your referral?...

I recommend behavioral health treatment specifically designed to help @FNAME@ learn skills to manage @HIS@ [headaches, abdominal pain and/or GI discomfort, medical condition]. I have referred @FNAME@ to Streamind Health, which is a short-term online therapy program for children and teens with [abdominal pain, headache, medical conditions, health concerns]. To learn more about Streamind and make an appointment, please call their intake coordinator at 707-666-3397, email at info@streamindhealth.com, or place a self-referral at www.StreamindHealth.com/referrals.

Dotphrase

Pediatric Neurologist, CA

"I highly recommend Streamind! Historically, access to high quality CBT-HA has been extremely limited. Streamind has changed this. My patients love the flexibility that the tele-therapy offers. I have numerous patients who have completed treatment through Streamind and have had a significant reduction in their headache frequency. The referral process is easy and the therapists are easy to communicate with to coordinate care. This is an exciting new model of care."

Call

707-666-3397

Email

info@streamindhealth.com

Medical Personnel Referrals

1

2

Please arrange for documentation to be faxed to Streamind at 855-234-9106

Documentation should include:

Referring Provider’s Last Note:

Relevant Medical Documentation

Insurance Reimbursement

3

Looking for a dotphrase to accompany your referral?...

Call

Email

Follow

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