Contact

Prospective clients can use the form on this page to request a free 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*

Email*

Phone*

Age*

How did you hear about me?*

Which services are you interested in discussing?*

Hypnotherapy (clinical hypnosis)

Talk therapy (clinical counseling)

Relationship/Family Counseling

Coaching (non-clinical self-improvement)

Hypnosis for Self-care (non-clinical)

About rates and insurance

I do not accept or bill insurance at this time. Please review service rates to be sure that self-pay will work for you before proceeding with a consultation.

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

Yes

How can I help you?

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

I make consultation calls during the following times. Please choose which timeframes will work for you.*

Monday 12pm-1pm

Fridays 12pm-1pm

Request a different time

Time requests cannot be guaranteed, but I will try my best to connect with you.

If you do not answer, may I leave a message?*

Yes

If I cannot reach you by phone, may I respond to your question(s) by email?*

Yes

By submitting this form, I acknowledge and accept the risks of communicating health information by email.

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Anthony J. Rotolo, Ph.D.

34 Oxford Road

New Hartford, NY 13413

(315) 316-1989

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