The Root Therapy NYC Inquiry Form
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 (and/or referral you represent w/ relationship) *
Email *
Phone# *
Which day(s) are ideal for treatment? *
Which time(s) are ideal for treatment? *
Which therapist are you interested in working with? We welcome you to view our team of experts' clinical background, level of expertise and specialty on our website: *
To assign you with a therapist aligned with your goals, please share preferences and/or needs for treatment. *
How did you hear about us? *
If a direct referral, please specify who referred you to our practice
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 Supervisor will contact you within 72 business hours to schedule your free 15 minute consultation. For additional information about our practice, we welcome and encourage all to visit our virtual communicative platforms:

Phone: 347-389-3920
Never submit passwords through Google Forms.
This form was created inside of Katherine Casey LCSW LLC. Report Abuse