Community Partner Referral

Referral on behalf of a patient

At Athena, we simplify the referral process for healthcare professionals. If you would like to refer a patient for mental health services, simply complete the form below. Once submitted, our team will reach out directly to the patient to arrange their first appointment.

Referrer or Referring Campus * Referrer Email * Patient's First Name * Patient's Last Name * Patient's Date of Birth * Patient's Phone Number * Patient does not have a phone number (use email instead) Patient's CIN/Member ID * Email * Patient's Preferred Language (if not English) If the client requires continuation of an existing medication prescription, please indicate the medication name, dosage, and the amount remaining. * Brief Reason for Referral This referral has been discussed with the patient and they consent to being contacted by Athena via phone, text message, and/or email in order to schedule an appointment

A new referral option for NewYork-Presbyterian patients

Referral on behalf of a patient

Services

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A new referral option for NewYork-Presbyterian patients

Referral on behalf of a patient

Services

Content

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