Support & Consultation Request Form

I I State

Use this form to tell us about your interests in 1:1 support, consultation and/or training.

You should expect a response within four days. If you do not receive a response within that time, you can also reach out to us at info@rootsup.info in case there was a glitch in the system!

I am:

Seeking personal support/consultation for myself (Can include advocacy support or similar)
A family member or friend seeking to better support someone in my life
A formal supporter or provider seeking consultation (Peer supporter, clinician, first responder, doctor, faith leader, etc.)
An organization seeking consult for a team, leadership, etc.
Other

Please note that we are in the process of launching 1:1 supports and consultations. During the launch period, anyone can request one free support session, but anything after that first session will be paid. If ou have the means to do so, you can choose to skip the first free session and go directly to paid sessions via our sliding scale.

You can learn about our pricing - including our sliding scale - during our launch period by clicking here.

Pricing will be updated once our launch period has concluded and sliding scales have been finalized.

I am requesting:

A paid session (I've already had a free session or do not need a free session)
A free session (this is my first session)

Please note that we are in the process of launching our consultation offerings. During the launch period, any formal supporter or provider can request one session at $50. Anything after that first session will be paid on our sliding scale. If you have the means to do so, you can choose to skip the reduced price session and go straight to our sliding scale.

You can learn about our pricing - including our sliding scale - during our launch period by clicking here.

Pricing will be updated once our launch period has concluded and sliding scales have been finalized.

I am requesting

A paid session based on the sliding scale (I've already had a reduced-price session or do not need a reduced-price session)
A reduced-price session at $50

Name

First

Last

Pronouns (she/her, he/him, they/them, ze/zir, etc.)

Organization/Group Name (if applicable)

Email

Phone

State / Country (This helps us be aware of any time differences, etc.)

Tell us a little bit about why you're seeking support/consultation. (Just what you're comfortable sharing!)

In a perfect world, would the person you meet with have any particular life experiences? (For example, Working as a peer supporter, member of LGBTQIA+ community, etc.)

Anything else you want to share about your request? (For example, is there anyone in particular you were hoping to meet with?)