Please fill out the following form as accurately and honestly as possible. We ask you to fill this out no later than 24 hours prior to your appointment. If you do not fill this out you will be required to fill this out prior to your appointment and it may cut into your treatment time. We ask you be on time and not early due to Covid for your appointment. In order to avoid any inconvenience please fill out this form ASAP.

NOTE: If you’re appointment is cancelled by the clinic please note no fees apply and any applicable upgrades for a new appointment are subject to availability and therapists discretion. Thank you.