Seven Starling | Secure Referral Form

Seven Starling Referral Portal

Your patient will receive outreach from a Seven Starling Care Coordinator immediately upon referral.

Seven Starling treats anxiety, depression, and trauma through infertility, miscarriage & loss, pregnancy, postpartum (0-2 years), early parenthood (2-5 yrs), perimenopause, and menopause.

✓ No waitlists; immediate availability
✓ Individual Therapy, Group Therapy, and Medication Management
✓ In-network with most major commercial insurance plans and some Medicaid plans

🔒 This portal is HIPAA compliant.

Patient First Name:
Patient Last Name:
Patient Phone Number:
Patient Email (while not required, having email dramatically increases the likelihood that we will be able to connect with your patient):

Patient consents to receive SMS, phone, and email outreach from Seven Starling. A Care Coordinator will reach out to them directly.

Referring Provider or Case Manager Name:
Referring Provider NPI (if applicable):
Referring Practice or Organization Name:

Which of the following best describes this patient's current experience and reason for seeking support?

Type or select an option:

(Optional) Other comments: