Step-By-Step Patient Referrals

Complete Simple Referral Form

Fax Relevant Records

Consider Our Referral Resources

(optional)

Referral Process

Referral Form

1

Complete Referral Form

Place a HIPAA compliant referral here if you have a patient aged 12-17 years old in California experiencing symptoms of ongoing abdominal pain/IBS or headaches.

Referral Form

2

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.

3

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]. I have referred @FNAME@ to Streamind Health, which is a short-term online therapy program for children aged 12-17 years-old with [abdominal pain or headache]. To learn more about Streamind and make an appointment, please call their intake coordinator at 707-666-3397. You can also visit their website at www.StreamindHealth.com.

Dotphrase

We understand the problem our colleagues experience and the lack of adequate referral resources available to them. We are here to provide an accessible solution that improves your practice and your patient's outcomes.

General Pediatrician, CA

"The type of service we (as pediatricians) have always needed, but haven't had access to. Up until now, pediatric health psychology has been more of a theoretical textbook treatment option, but hopefully soon will be an accessible, valuable resource for patients and families that providers in the community can refer to."

Call

707-666-3397

Email

info@streamindhealth.com

Referral Process

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?...

We understand the problem our colleagues experience and the lack of adequate referral resources available to them. We are here to provide an accessible solution that improves your practice and your patient's outcomes.

Call

Email

Follow

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