Interested in Becoming a Client?

Complete the following questions:

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Phone*

I am available online or in person for counseling and support. Which format do you prefer?*

Are you planning on using your health insurance? If so, what company are you insured through?*

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New Client Forms

Once Cynthia has made contact with you and confirmed you are a good fit to become a new client, please complete the forms below.

Patient Registration (pdf)

Download

Consent for Treatment (pdf)

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Client History (pdf)

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Submit your New Client Forms Here

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Phone*

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Deep Roots Family Therapy

2600 North Reynolds Road, Toledo, Ohio 43615, United States Suite 101A

P: 4193245518 | E: Cynthia@deeprootsft.com

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Wilson Management & Consulting LLC

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