Refer a patient for virtual mental health care —with appointments available in 48 hours or less

  • Precision psychiatry
  • Support for mood and anxiety disorders

Refer a patient

How it works

  • Select the patient’s state
    Currently servicing patients in NY, NJ and FL.
  • Complete your referral
    Enter the patient and provider information in this simple form. If you would prefer to fax us a referral, you can download this form and fax it to us directly.
  • Patient receives a text message
    We’ll send the patient a text with a unique activation link to get started.
  • Provider receives ongoing updates
    We’ll send the provider treatment updates.* If you’d like to have your patient complete our HIPAA consent to release medical information in advance to get this set up, please ask your patient to complete this form.

*Subject to patient consent

As a courtesy to the patient and ReKlameHealth, we cordially ask that you obtain the patient’s verbal or written consent for this referral prior to submission.

Who & what we treat

ReKlame Health is available to people 18 years and older.

Mental health conditions we treat:

  • Generalized anxiety disorder
  • Major depressive disorder
  • Panic disorder
  • Phobia
  • Social anxiety disorder
  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Seasonal affective disorder (SAD)
  • Postpartum depression
  • Premenstrual dysphoric disorder (PMDD)
  • Insomnia
  • Bipolar disorder
  • ADHD
  • Addiction

Preferred ReKlame Provider Name

Patient’s State

Patient Information

Provider Information

Please attach the filled HIPAA consent form

By submitting this referral, you are formally acknowledging that the information provided herein is, to the best of your knowledge, entirely accurate. Furthermore, you are representing yourself as a healthcare provider or representative of a healthcare entity legally authorized to treat the aforementioned patient, and that dissemination of any patient health information from ReKlame Health, Inc. to you or the entity you represent is being requested for the sole purpose of rendering future care to the referred patient.

741-741

If you’re in emotional distress, text HOME to connect with a counsellor immediately.

911

If you’re having a medical or mental health emergency, call 911 or go to your local ER.