Referral Form

Upon Referral, Your Patient Should Expect the Following:

• Intake — Our intake nurse will contact your patient to schedule a phone call for an initial intake, and we will discuss relevant medical history, prior/current medications, therapy history, and insurance eligibility for our services.
• Medical Consult — Our office will schedule a visit for your patient with one of our healthcare providers to determine which treatments are medically indicated. Victory clinic offers both SPRAVATO® (esketamine nasal spray) and TMS. In-person and telehealth consultations are available. In-person consultation is preferred.
• If patient is a candidate for SPRAVATO® or TMS, our office will obtain prior authorization. All treatments are done at our office.
• During treatment, we recommend that our patients continue to receive care from their healthcare providers and continue in therapy with their therapist.
• Our office will update referring provider on treatment and outcome.

Watch the video to learn how Victory Clinic works with providers.