Referrals – Serene Minds Behavioral Health LLC

Patient Referral Form

Email:
info@serenemindsbh.com

Fax:
575-205-0470

Serene Minds Behavioral Health LLC

Attention: Marren Onyalo, DNP, NP-C, PMHNP-BC

Patient Name

Date of Birth

Gender

Male Female

Phone #

Address

State

Zip Code

Referring Clinic Information

Clinic Name:

Phone #

Fax Number

Referring Provider Name

Title/Role

Insurance Information (if available):

Primary Insurance Provider:

Primary Insurance Holder:

Policy Number

Group Number

Psychiatric Evaluation Psychiatric Medication Management Psychotherapy

Message

Thank you for choosing Serene Minds Behavioral Health LLC as your partner to in Mental Health Care. We value your trust and look forward to working collaboratively with you to deliver high-quality care for your patients. Our team will confirm the appointment directly with your patient/guardian.

Fax

575-205-0470

Telephone

+1 (575) 454-3942

Email

info@serenemindsbh.com

Location

1209 Mountain Rd PL NE, STE N Albuquerque, NM. 87110

Patient Referral Form

Fax

Telephone

Email

Location

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