Mind Matters ECHO Case Presentation Form
Thank you for your interest in participating in the Mount Sinai Health Partners Mind Matters ECHO! Your participation is vital to our learning community!

Mind Matters ECHO, an application of Project ECHO, was designed to provide a collaborative learning space for clinicians in primary care. We hope that participation in the Mind Matters ECHO clinic, and engaging in case-based discussion, will allow clinicians to feel greater confidence in managing behavioral health conditions that present in primary care. Ultimately, Mind Matters ECHO aims to improve screening and treatment of behavioral health conditions within primary care settings.

Please submit this form if you are interested in presenting a case at an upcoming meeting and a member of our team will be in touch shortly!

If you have any questions about your submission, please email anitha.iyer@mountsinai.org

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Provider Name *
Provider Email *
Provider Phone Number *
Practice Name *
Has your patient been diagnosed with any of the following, or do you suspect your patient should be diagnosed with any of the following? (please check all that apply)
Why are you seeking support with this case/patient at the present time? (Check all that apply) *
Required
In a couple of sentences, please explain the case and your reasons for seeking consultation. No need to go into depth here - we will collect more detailed information once we confirm your presentation. *
Desired presentation date *
Any other comments or questions for our team?
Submit
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