Clinician Referrals

Testing only. Not yet open for live referrals. Access to the test form is limited to approved testers. Use made-up examples only.

This referral process is for clinicians at hospitals, clinics, and professional practices. It is not for patient self-referrals.

Before you begin

Choose a neutral case code assigned by your clinic, up to 40 characters. Keep the code-to-patient mapping privately in your clinic’s own system. Do not use names, initials, dates of birth, medical record numbers, or other patient identifiers in the code.

Do not enter patient contact information, addresses, clinical narratives, or identifying details anywhere in the form. Discuss individual clinical details privately through approved clinical channels.

Complete the form

• Choose the broad age range, insurance/payment category, county, service, support need, and preferred format: in person, telehealth, or hybrid. Gender is optional.
• Choose Open for a new referral.
• Enter your clinic’s neutral case code, then the referring clinician or clinic name and a professional phone or fax number. Do not enter the patient’s contact details.
• Sign in with the Google account approved for testing. Google collects your verified email and emails a copy of your response.

Keep your referral current

Keep the Google response email and its private Edit response button. Use it to update the referral or change its status to In discussion, Placed, or Closed. Placed and Closed referrals disappear from the active list. If the email is missing, check spam; you can also save the edit link on the confirmation page. Keep edit links within the submitting clinic and never forward them.

This is not an emergency service and is not continuously monitored. A submission does not guarantee placement or acceptance of care. The referring clinician remains responsible for follow-up until an accepting clinician confirms the handoff and next step.

Open the restricted test referral form

Patients seeking a therapist can use our therapist directory.