New Client Intake

Let's start with a little about you.

Everything you share here is confidential and handled with care. I'll review your intake personally and get back to you within 1–2 business days.

Please don't include emergency or crisis details in this form. If you or someone you know is in immediate danger, call 988 (Suicide & Crisis Lifeline) or 911.

Your full name

What is your current age?

Are you looking for a…

Free 15-min consultationA short intro call to see if we're a fit.Full 50-min sessionA standard therapy session.

What's been going on that's led you to seek therapy right now?

Feel free to share as much or as little as you'd like. If there's a specific situation or life change that's been weighing on you, I'd love to know about it.

Are there particular goals, challenges, or areas of your life you'd like to work on?

Have you worked with a therapist or other mental health professional before?

I understand this form is not for emergencies and that submitting it does not establish a therapist-client relationship. I consent to Rachel Troob, LMHC storing this information securely to respond to my inquiry, as described in the Privacy & Consent policy.

Your responses are stored securely and only reviewed by Rachel.

Contact me

Questions? Reach out directly.

Phone646-450-9032

Emailrachel@racheltroobtherapy.com

HoursMonday–Friday, 9am–6pm