Referral Request

Thank you so much for considering us for considering our practice for your patient or client!

Our clients are often busy, multipassionate, driven professionals, executives, physicians and healthcare professionals, lawyers, entrepreneurs, athletes, creators, and public figures who want more from life while doing less. Because they need wellness options that optimize their time, offer location flexibility, are uniquely tailored to their needs, and are delivered by highly-trained specialists. Please review our General FAQ and Investment FAQ and keep the following in mind before referring your patients:

• We are 100% private pay. We don't accept third party insurance. We do provide superbills for reimbursement and accept some HSA cards.
• Our practice is 100% online using a HIPAA-secure telehealth platform and portal. We don't offer in person sessions.
• We only work with adults. We work with many psychological problems, but currently we don't accept referrals for therapy with individuals who have serious mental illness (SMI) including psychotic disorders, personality disorders, or disorders that could make the medium of telehealth too challenging for the patient to benefit.
• Our psychologists are all members of PSYPACT, so we can work with clients in over 39 states.
• All of our psychologists have PhDs in clinical psychology representing the highest education and training in our field.

Patient Information

Physical Location for Online Telepsychology Services

What services does your patient need?

How would you like us to respond?

If the provider would like us to contact them, please include email and phone. Email works much better for our providers due to their schedules. If you would like us to contact the patient directly, please note that:

• We do not contact patients directly based on your referral form unless you include a signed authorization along with this request.
• In general, we recommend that you send this referral form and then ask your client to complete our intake form as well. Here is the link: Request an Appointment - Momentum Psychology, PLLC (hushforms.com)

Desired Provider

Please click here for a list of our current psychologists and their bios.

Click here to check out our providers' rates.

About the Patient and Their Concerns

Want to stay connected? We believe in self-empowerment! Please check here or click on this link if you would like to be added to our email list to learn about new tools and resources for personal development.

Want free stuff right now? For free resources, check out our blog and all of our curated resources in one place.

Need help with managing stress and burnout FAST? Check out our services and this blog article with 7 tips from a psychologist on how to slay stress and banish burnout.

Process

We will try to respond to your request within 1 - 2 business days. Please contact our office at 704-444-0087 or email our Client Coordinator, Kristin Coen, at hello@momentumpsychology.com for more information.

*Your submission of this appointment request does not constitute a therapeutic relationship. By submitting this form and including your email, you are consenting for us to contact you about scheduling via email.