How to Refer a Patient

To request a referral:

  • Complete the Online Referral Form (pdf) below and send recent treatment notes via fax to (859) 277-1083 or fill out the form below. Please note, the referral is not complete without recent notes.
  • Or you can call (859) 277-1008 to speak directly with a scheduler.
  • Or fax a complete copy of our referral form (PDF below) with the patient’s demographics and recent treatment notes to (859) 277-1083.

*Patients seen in our Lexington office are typically scheduled within two weeks.

Main Office

Bluegrass Health Psychology
2220 Young Drive
Lexington, KY 40505

Office Hours

Appointments are available during normal business hours:

  • Monday to Thursday: 8:00am to 5:00pm
  • Friday: 8:00am to 4:00pm.

Phone

Phone: (859) 277-1008
Fax: (859) 277-1083

Email

info@bluegrasshealthpsychology.com

Referral Form (PDF)

View/Print our BHP Referral Form.

Online Referral Form

We value our relationship with our referring physicians.  We will provide excellent care to your patient and timely feedback to you.  Thank you for choosing Bluegrass Health Psychology for your healthcare needs.

An (*) asterisk indicates a required field.

    REFERRING PROVIDER DETAILS

    Provider Name*

    Provider Specialty

    Provider's Location or Facility Name*

    Provider Phone*

    Provider Email*

    Reason for Referral*

    PATIENT INFORMATION

    First Name*

    Last Name*

    Patient's Date of Birth:

    Email*

    Telephone*:

    Patient's Address (Street Address, City, State and Zip)

    Patient's Insurance Company*:

    Patient's Insurance Policy ID Number*:

    Patient's Secondary Insurance:

    Any comments

    UPLOAD FILES

    Upload patient demographics, insurance, and recent treatment notes.
    (Acceptable files formats: JPG, PDF or PNG)

    Let's work together.

    We are clinical and health psychologists with specialized training to help people cope with a variety of medical conditions including:

    • Bariatric Surgery Evaluations
    • Spinal Cord & Peripheral Nerve Stimulator Evaluations
    • Intrathecal Pain Pump Evaluations
    • Insomnia Evaluations
    • Chronic Pain Evaluations
    • Insomnia Treatment & CPAP Tolerance
    • Behavioral Pain Management & Coping Skills
    • Post-Surgical Adjustment & Coping

    Meet our Providers
    Schedule an Appointment