Thank you for referring a new patient to Kaizen Collective!

Please send the following information to us via fax or email:

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• Full Legal Name

• Preferred Name and Pronouns

• Date of Birth

• Textable Phone Number

• Current Insurance (Photos of Front/Back)

• Reason for Establishing Care

 

If you have a completed referral document from another source (such as your EHR) you may fax or email it: 
Fax your referral:  (618) 822-4174 
Email:  info@kaizenpsychiatric.com.