* The Root Therapy NYC Inquiry Form *
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At The Root Therapy we like to think of the therapeutic relationship as a one-sided friendship: a safe space to talk about anything with someone who has your best interests at heart, knows just what to say, and can give you tough love when needed.
Full name w/ pronouns *
Email *
Phone# *
Type of treatment? Select as many as needed: *
Required
Who needs treatment? Select as many as needed: *
Required
Days for treatment?  Select as many as needed: *
Required
Times for treatment?  Select as many as needed: *
Required
Preference for Connectivity? *
Please select a therapist. We welcome you to view our team of experts' clinical background, level of expertise and specialty on our website: https://www.theroottherapynyc.com/team/  *
Briefly share your needs for treatment. *
Our practice is committed to making therapy equitable and accessible without compromising the quality of services. We are in network with Aetna commercial plans, offer fair market rates ranging from $75-300, support with reimbursement for out-of-network insurance coverage, and subsidized treatment. We also offer subsidized treatment with those with budget limitation.  Are you hoping to use insurance to cover the cost of services?
 *
If you have Aetna Commercial Insurance, we will need: Group #, Individual ID #, and primary member's name & DOB: *
We're so glad you're here! How did you find us? *
If selected "Another Provider/Direct Referral", would you please share their name and contact info?
Here at The Root Therapy NYC, our clinicians' primary therapeutic goals are to help guide you to “the root of the root”,  so that your life can be a flourish of possibilities!
Once submitted, a Clinical Intake Coordinator will contact you within 72 business hours to schedule your complimentary consultation. For additional information about our practice's services, we welcome and encourage you to contact us or visit below

Phone: 347-389-3920 (call or text)
Website: https://www.theroottherapynyc.com/
Email: contact@theroottherapynyc.com
Facebook: https://www.facebook.com/theroottherapynyc 
Instagram: https://www.instagram.com/theroottherapynyc/ 
Link Tree: https://linktr.ee/theroottherapynyc 
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This form was created inside of Katherine Casey LCSW LLC.