Referral Process

Please ask the patient/client to call the office at (319) 343-1696 to schedule AFTER faxing or securely emailing patient summary information (see below).

 

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FAX TO (319) 251-5918

Email: sarahk@skhealthy.com

 

Office Address:

332 S. Linn St. Ste 2

Iowa City, IA 5224

 

PLEASE INCLUDE THE FOLLOWING INFORMATION IN A PATIENT SUMMARY

 

1. Referring provider name and contact information

2. Patient:

   • List client demographics (DOB, address, cell and home phone, email)

   • List mental health diagnosis (es)

   • List past medical history (chronic illnesses, hospitalizations, surgeries, ER visits, serious injuries, head injuries)

   • List current Medications and prescriber for each

   • Indicate regular pharmacy with address

   • List client goals

   • Chief concerns - is this a request for consultation or transfer of care request?

   • Name/Address/Phone/Fax of Primary Care Provider if different from referring provider. If none please note “none”.

Thank You!