What is an impegnativa
An impegnativa is the red prescription issued by an Italian general practitioner (medico di base) that grants access to subsidized specialist psychiatric care under the national healthcare system (Servizio Sanitario Nazionale).
The impegnativa is the official referral document issued by your medico di base (family doctor) in Italy, printed on a distinctive red form, that authorizes access to specialist psychiatric services at reduced or no out-of-pocket cost under the national health system. Without it, most visits to a psychiatrist covered by the Servizio Sanitario Nazionale (SSN) are not possible.
To obtain an impegnativa, you contact your GP and describe your need for psychiatric evaluation or treatment. The doctor assesses whether specialist care is appropriate and, if so, issues the form. The referral typically specifies the type of psychiatric service needed (initial evaluation, ongoing treatment, specific conditions). You then use this form to book an appointment at an SSN-accredited psychiatrist or mental health clinic in your area. Milan has a network of public and affiliated providers that accept impegnative referrals.
The impegnativa system exists to regulate access to specialist care and control SSN costs. It ensures that public psychiatric resources are directed to patients with documented clinical need rather than offering open walk-in access. Some people bypass the system entirely by paying out-of-pocket to see private psychiatrists without a referral, but the impegnativa remains the standard pathway for subsidized care. The form is valid for a set period (usually 90 days) and may require renewal if specialist care continues beyond that timeframe.