Online Contact Request

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Let us know what you are looking!

*** Please note that therapists are not employed by Authentic Roots. All therapists are independent operators. All record requests, and communications outside of this contact form should be sent directly to your provider.***

www.AuthenticRootsTherapy.com

7077 Northland Circle N.
Suite 330
Minneapolis, MN 55418

Email *

Name (first and last) *

Date of Birth *

YYYY

Phone *

Address *

Preferred Therapist (feel free to submit multiple forms for different providers)

IF YOU DO NOT HAVE A PREFERENCE PLEASE SELECT "Therapists@AuthenticRootsTherapy.com"

Please note if you submit to 'Therapists@AuthenticRootsTherapy' you will most likely receive emails from numerous providers. Feel free to choose the one that feels like the best fit for you!

Please reach out to Info@AuthenticRootsTherapy.com if you do not hear from a provider within 48 hours(not including holidays and weekends).

Telehealth(video) or In-Person *

Telehealth Only

In-Person Only

Open to Telehealth and In-Person

What specifically are you looking to work on? *

How did you hear about Authentic Roots Therapy? *

How will you be paying? *

Insurance

Private Cash Pay ($150)

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