New Client Intake

New Client Intake Form:

IMPORTANT - You are required to complete the intake form prior to your first appointment. Once you have completed the form, you will be directed to the scheduling page.

* all fields are required

New Client Intake Form:

* First / Last Name:

* City / State

* Phone:

* Email:

* Age:

* Gender (select one):

* Height (select one):

* Weight:

* Referred by (select one):

* What, if any, medications do you take?:

* Goal for first appointment:

* Current health issues & other notes:

* RESCHEDULING & CANCELLATION FEE:

* If you cancel or re-schedule with less than 24 hours notice, or don't show up on time for your appointment, there is a cancellation fee of one-half (50%) the cost of your scheduled appointment.