Request an Appointment

Client's Name *

If this appointment is for a child, input child's information.

First Name

Last Name

Date of Birth *

If this appointment is for a child, input the child's information.

MM

DD

YYYY

If this appointment is for a child, input parent's full name.

First Name

Last Name

Phone Number *

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###

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I am interested in the following service(s): *

check all that apply

Therapy

Comprehensive ADHD & Autism Evaluation (A $500 deposit is required when scheduling the initial intake appointment)

ADHD Evaluation Only (A $500 deposit is required when scheduling the initial intake appointment)

Autism Evaluation Only (A $500 deposit is required when scheduling the initial intake appointment)

Executive Function, Sensory Processing & Interoceptive Awareness Assessment (A $500 deposit is required when scheduling the initial intake appointment)

I acknowledge the following: *

True Reflections Mental Health Services DOES NOT ACCEPT INSURANCE and is an OUT OF NETWORK PROVIDER. The full fee is due at the time of the appointment and a statement of reimbursement is provided to those submitting to their insurance for out of network benefits. For information on fees, please visit: https://www.truereflectionsmhs.com/fees-out-of-network

True Reflections Mental Health Services sees clients on Tuesdays, Wednesdays, and Thursdays 10:00am-4:00pm. Upon request, I am able to provide a letter excusing you from work or your child from school due to having to attend your clinical appointment.

True Reflections Mental Health Services does not specialize in high conflict divorce cases. If this appointment is for a child, written consent is required from both parents if parents are separated/divorced. Written signed consent must be provided electronically in order to be able to request an appointment. Be advised, that I do not participate in any court related matter and do not offer an opinion or recommendation, especially as it relates to custody.