Request an Appointment

If this is an emergency, please call 911.

I'm already a client.

Please check all that apply.

Established Clients

Scheduling a Follow-Up Appointment:

Current clients with New Roots Counseling are encouraged to use the Client Portal to schedule follow-up appointments.

Important: After clicking the Client Portal link, you will be prompted to sign in using your password. If you don't have a portal account yet, please send a request for help and a description of the problem using this secure form link below. Click here if you have an account and forgot your password.

Sending Your Counselor a Message or Document:

Use this link to send secure and encrypted messages to your counselor.

The client is a child or minor (2-17 years old)

I have a current or pending court case. (e.g. custody or divorce)

Important information for clients or parents with a pending or current court case.

Click the link for details and fees for legal requests involving your counselor.

Parent/Guardian Information

Contact Information

First name

Last name

Email address

Referred by

How did you hear about New Roots Counseling?

Phone number

SMS Text & Email Messaging Consent New Roots Counseling would like to text and email you information about appointment scheduling and our available counseling resources.

To consent, please check the box to acknowledge receipt of our privacy practices linked below.

Click here to learn more about our privacy practices.

Client Information

First name

Last name

Age

Date of birth

School info

Name of school, grade level, or year (if applicable)

Email address

Client's Email (if applicable)

Phone number

Client's Phone # (if applicable)

Current Diagnosis

List any current diagnoses if applicable.

Check if applicable

IEP or 504 plan

About Your Appointment

New: Virtual Therapy (or Telemental health) is available for Adults and Parents. Check if applicable

Yes, I am an adult or parent client interested in virtual therapy sessions.

What is your preferred appointment time?

Days of the week

Availability Mon.-Sat.

Time of Day (mornings or afternoons)

Between 9 AM to 5 PM.

Reasons for seeking therapy?

Important information for appointment

Please describe any important details.

Is there anything else you'd like to share?

Your information will be encrypted.