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TCAPES Consultation Request Form

This Form is For Primary Care Providers Only

TCAPES is for Tennessee providers seeing patients 21 and under. During business hours, Monday through Friday from 8:30 a.m. to 5 p.m. (except on public/institutional holidays), Child and Adolescent Psychiatrists, Psychiatric Mental Health Nurse Practitioners and Physician Assistants, Licensed Clinical Social Workers, and Behavioral Health Specialists are available on The TCAPES Line to consult with providers on pediatric mental health concerns. To receive support, please call 833-281-5020 or complete the form below.

If you would like a call within the next hour, please call 833-281-5020 instead of submitting this form. For Suicide Emergencies Dial 988.

A TCAPES team member will call you during the requested time to complete a brief intake. Your request will then be forwarded to the appropriate specialist. If calling for a consultation with a Child and Adolescent Psychiatrist, Psychiatric Mental Health Nurse Practitioner, or Physician Assistant, we will connect you within 30 minutes. Please have the patient's information available during the callback time you select.

Consult Request

Please complete the consult request form below.

Provider First Name

* must provide value

Provider Last Name

* must provide value

Provider NPI Number

* must provide value

Preferred Callback Number

* must provide value

Provider Email

* must provide value

Preferred date you would like to be contacted for your consultation (Monday-Friday)

* must provide value

M-D-Y

Preferred time window you would like to be contacted for your consultation (can select multiple time windows)

* must provide value

8:30 AM - 9:59 AM

10:00 AM - 10:59 AM

11:00 AM - 11:59 AM

12:00 PM - 12:59 PM

1:00 PM - 1:59 PM

2:00 PM - 2:59 PM

3:00 PM - 3:59 PM

4:00 PM - 4:59 PM

Patient Age Group

* must provide value

Provider Practice County

* must provide value

Does the patient have insurance?
Information is utilized to evaluate the available resources.

* must provide value

Insurance Type

Are you enrolled in the Tennessee Child and Adolescent Psychiatry and Education Support (TCAPES) program?

* must provide value

Yes

Unsure

reset

If you have not enrolled, please enroll here after submitting your consultation request form. Enrollment is free to providers and helps us streamline our response to consultations and help sustain our funding so that we can continue to provide this service. Please visit our website for more information about the program and our services here.

Please share information you would like the TCAPES team to know:

Do not share protected health information.

* must provide value

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