Partnering for Patient Care
At Empower You Mental Health & Wellness, we partner with referring providers to deliver safe, evidence-based care.
We offer SPRAVATO® (esketamine) for treatment-resistant depression and psychiatric medication management. We aim to complement, not replace, your care.
Referral Options:
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Spravato-Only: Evaluation and in-office treatment, with the patient returning to you for ongoing care.
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Co-Management: Shared care, including medication management as needed.
How to Refer
- Submit the referral form online below (or send via email/fax).
- Our team will contact the patient within 24–48 hours.
- We coordinate care and provide updates to you as appropriate.
Printable Referral Form
"With patient consent and a completed Release of Information (ROI), referring providers will receive timely updates. Patients may return to their primary provider after treatment if preferred."
If you prefer to fax or email your referral, you can download our printable form here:
Download SPRAVATO® Referral Form (PDF)
Online Referral Form
Please fill out the form below to submit a referral securely online.
Contact Information
If you have any questions or need to send documents directly, please reach out to our team: