• NEW CLIENT FORM
  • Please fill in all of the information to the best of our ability. 

    * This information will be kept strictly confidential. Your personal information is collected for the purpose of providing health care and for administrative purposes.  It will not be disclosed for other purposes without your consent other than for reasons stated in the laws.

  • Demographic Info


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  • Appointments & Fees

  • Missed Appointments

    We require at least 24 hours notice during business hours and by phone if you wish to cancel or reschedule an appointment, or you will be charged the full fee of the missed appointment, and in the case of a scheduled treatment, the cost of non-reusable supplies and products prepared for you. (i.e. Monday appointments must be cancelled on the Friday before closing at 5pm.)

  • Should be Empty: