Beyond the Blues: Consultation Form

www.beyondtheblues.info

Consultation Service for Healthcare Providers - Online submission form

Date:

Your name:

What type of healthcare provider are you?

Advanced Practice Nurse
Family Practitioner
Nurse
Nurse Midwife

Obstetrician/Gyn
Pediatrician
Physician Assistant
Psychiatrist

Psychologist
Social Worker
Other:

At what hospital, clinic, agency do you work?

In 100 words or less, please provide the question you would like us to consult about:

What is the best way to reach you with our reply? E-mail Phone Fax

Phone number:

Best day(s) to call: Monday; Tuesday; Wednesday; Thursday; Friday

Best time(s) to call:

Fax number:

E-mail address:

This service provides consultation to healthcare providers who have questions about screening, diagnosis, treatment, or referral regarding perinatal mood and anxiety disorders. Consultants are University of Iowa psychiatry faculty.

While providers seeking consultation may call this line or submit a query form for information in order to make treatment decisions about a particular patient or patients, this service does not consult directly to or about individual patients, and should not be construed as direct advice about managing any particular patient’s care.

We strive to provide immediate phone consultation or feedback to query forms whenever possible. However, please note that this is not a “hotline”. Questions will generally be answered or responded to within one business day.

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Iowa Department
of Public Health

Funding for this project was provided by U.S. Department of Health and Human Services, Health Resources and Services Administration.