Contact — Reflejo Psych

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Reflejo Psych

English

Reflejo Psych

English

Let’s work together

Note: I am currently not accepting new (kid or adult) clients. If you are interested in being on my waitlist please fill out the form below.

PHONE

401.213.9766

By contacting me, you acknowledge that phone or text communication is not a secure form of communication by nature.

Name *

First Name

Last Name

Email *

Phone *

(###)

###

####

Date of Birth (of person needing services)

MM

DD

YYYY

What services are you interested in?

Individual Therapy

Play Therapy

WPATH Letter

Immigration Evaluation Letter

Where would you prefer to meet for services?

If you feel comfortable, please tell me a bit about yourself (or your loved one)

For example: gender identity, ethnicity, religion)

Please tell me why you are seeking services at this time *

Insurance Provider

Are any of these currently present for you or the person seeking services?

Serious thoughts of self-harm or suicide

Abuse or domestic violence

Lack of safety at home or work

Aggressive or violent tendencies

Shared custody or legal guardianship

How did you hear about me?

How do you prefer I respond to your message?

Phone

Email

Text

Thank you!

reflejopsych.com