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HOME
ABOUT US
SPECIALITIES
ADHD/ADD
MOOD DISORDER
ANXIETY DISORDER
PTSD AND TRAUMA DISORDER
PSYCHOTIC DISORDER
PERSONALITY DISORDER
SLEEPING DISORDER
SCHIZOPHRENIA TREATMENT
SYMBOLISM HEALING
DREAM INTERPRETATION / DREAM ANALYSIS
BEHAVIOR MODIFICATION FOR CHILDREN & AOLESCENTS
FOR PATIENTS
Privacy Policy Terms and Conditions
Tele Visit
Rates & Insurances
FAQ’S
PAY YOUR BILL
REFILL REQUEST
REFERRAL
CONTACT
BLOG
Menu
HOME
ABOUT US
SPECIALITIES
ADHD/ADD
MOOD DISORDER
ANXIETY DISORDER
PTSD AND TRAUMA DISORDER
PSYCHOTIC DISORDER
PERSONALITY DISORDER
SLEEPING DISORDER
SCHIZOPHRENIA TREATMENT
SYMBOLISM HEALING
DREAM INTERPRETATION / DREAM ANALYSIS
BEHAVIOR MODIFICATION FOR CHILDREN & AOLESCENTS
FOR PATIENTS
Privacy Policy Terms and Conditions
Tele Visit
Rates & Insurances
FAQ’S
PAY YOUR BILL
REFILL REQUEST
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Texas Psychiatry Group Health Referral Form
Texas Psychiatry Group Health Referral Form
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Name
Which of the following best describes you?
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Select a answer
ADHD/ADD
MOOD DISORDER
ANXIETY DISORDER
PTSD AND TRAUMA DISORDER
PSYCHOTIC DISORDER
PERSONALITY DISORDER
SLEEPING DISORDER
SCHIZOPHRENIA TREATMENT
SYMBOLISM HEALING
DREAM INTERPRETATION / DREAM ANALYSIS
BEHAVIOR MODIFICATION FOR CHILDREN & AOLESCENTS
In which state(s) do you practice?
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What is the patient's name?
Email Address
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Please provide a brief reason for your referral of this patient to Texas Psychiatry Group.
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In your professional opinion, what are the diagnoses of this patient?
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