First Name *

Last Name

Email *

Phone *

I want an appointment *

For myself

For child / minor patient

I am a Doctor / Provider office and want to refer a patient

I am the patient's legal guardian, and I assume the financial responsibility for the minor patient.

Dr. Reena Kumar does not accept any insurance at this time and self-pay rate will be applicable. *

Agree

Disagree

Please click this button to open the Referral Form

I need help with

Depression

Bipolar disorder

Anxiety / Panic attack / Social anxiety disorder

OCD

PTSD

Schizophrenia / psychosis

ADHD !!

Eating disorder !!

Autism !!

!! Please read the clinic policy before making the appointment.

Do you need help with any of these *

1- Developmental delays !!

2- I am currently having suicidal thoughts with intent and plan (please call 911 or go to nearest ER) !!

3- I need short term / long term disability / FMLA / Emotional animal support letter !!

4- I am suffering from Dementia / Memory Loss !!

5- I have been diagnosed with Personality Disorder !!

None of these apply to me

1-5: Sorry, we currently do not offer these services in our practice.

Dr. Reena's page

Autism :- We treat mild cases of autism only

Eating disorder:- We treat stable eating disorder cases as unstable cases need more intensive care, which may require full or partial hospitalization.

ADHD - Please refer to clinic policy

I understand

If you don't want to continue. *

Click here

Do you have insurance *

Yes

Do you have any of the following insurance *

Aetna

Blue Cross Blue Shield

Cigna

Humana

United Health Care

None of the above

Self Pay Rate

New patient - $400

Follow up - $200

We can provide the paperwork that is necessary for clients to file for "out of network" reimbursement from their insurance company directly. ( If requested) 

The "Reimbursify" app helps to streamline getting reimbursed from your insurance company. The amount reimbursed depends on your insurance plan.

Do you agree with self pay rate? *

Yes

Thank you for filling the screening form. Now you can fill the New patient paperwork. Once filled our team will contact you if any additional information is required. We will confirm the appointment once we receive all the required information.

Proceed

Decline