Request appointment | Rooted Therapies

Rooted Therapies

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Reason for care

Select date & time

1 Appointment info

2 Prescreener

Reason for care

3 Contact information

What is the reason for seeking care?

Anxiety Attentional difficulties Behavioral issues Depression Grief Relationship issues Substance use Trauma Other

What mental health concerns or treatment have occurred in the past?

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Known neurologic or genetic disorder Attempted suicide in the past None of these apply

What type of support are you seeking right now?

Individual therapy Couples Therapy Family Therapy Child/Teen Therapy

Have you participated in therapy, counseling, coaching, or mental health treatment in the past?

Yes No

Are you currently taking any psychiatric or mental health medications?

If yes, please list your current medication(s)

Are you experiencing any of the following

Please select all that apply

Personal safety Self harm Suicidal thoughts Substance use Eating disorders Domestic violence Significant emotional instability

Are there any current or past legal matters that may impact treatment, including

Please select all that apply

Divorce Custody disputes DCF involvement Probation Criminal charges Court orders Active litigation None of the above

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

Rooted Therapies

941.216.1406 |

North Port

Main Location

2562 Commerce Pkwy Unit B
North Port, FL 34289-9328

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THE CLIENT PORTAL IS NOT TO BE USED FOR EMERGENCY SITUATIONS. IF YOU OR OTHERS ARE IN IMMEDIATE DANGER OR EXPERIENCING A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.