Make a Referral

Thank you for trusting MindSpa Psychiatry & Therapy with your client’s your mental health needs. Please fill out the form and someone will be in contact with your referral. We serve Delray Beach, Lake Worth, West Palm Beach, Boca Raton, Royal Palm Beach and Wellington in Florida.

Name of person making the referral

Referral Email

Name

Phone

Message

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Yes, I want to submit this form & agree to the terms of use. *