Contact
New Prospective Counseling Clients:
Please complete the “Counseling Pre-Intake” form below, then email the completed form along with photos of the front and back of your insurance card to ashley@rooted-cc.com
Counseling Pre-Intake (fillable)
Counseling Pre-Intake (printable)
Please note: This pre-intake form is designed for completion on a computer and is not compatible with mobile devices.
I will respond within two business days
If you are in need of more immediate services, find crisis resources here. If this is an emergency, please call 911.
Prefer not to complete the pre-intake form?
No problem!
You’re welcome to use the below contact form instead.
By submitting this form, you consent to being contacted by Rooted Collective Counseling regarding your inquiry. You understand that the information you provide may include personal or sensitive information and will be collected and handled as part of responding to your request.