Contact

Use the form on this page to request a consultation.

Existing clients, please use secure messaging in the client portal or contact by phone.

Client Portal

(315) 316-1989

If you are having an emergency, call 911 or go immediately to the hospital emergency department.

Consultation Request

First name*

Last name*

Phone*

Email*

Age*

How did you hear about me?*

I understand that coaching (including hypnosis) is for educational purposes and not intended to diagnose, treat, or cure any medical or mental health conditions.*

Yes

I have reviewed the service rates and understand that full payment is due at the time of each session.*

Yes

Please review the pricing page to be sure the service rates will work for you before proceeding with a consultation.

How can I help you?

Which service(s) are you interested in? (check all that apply)*

Coaching for Self-Improvement Goals

Coaching for Relationship Goals

Coaching for Habit Change (ex. smoking, vaping, social media)

Hypnosis

Something else?

What are the main questions you would like to discuss?*

How would you like me to contact you?*

Text message

Phone call

When is the best time to reach you?

If I am unable to reach you, may I respond to your question(s) by email?*

Yes

Subscribe to my newsletter

Thanks for subscribing!

Anthony J. Rotolo, Ph.D.

34 Oxford Road

New Hartford, NY 13413

(315) 316-1989

bottom of page