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Appointment Request Form

Fill out the form below and I will reach out with availability and any questions I may have to get you on the schedule!

Business Hours:
Monday, Wednesday, Friday : 4pm - 9pm
Saturday: 2pm - 10pm
Tuesday, Thursday, Sunday: CLOSED
$80 MINIMUM
UNDER 48 HOUR BOOKING: +25
OFF-HOURS BOOKING: +$100

About You

Name

Birthday

Email Address

Phone Number

Did someone refer you? If Yes, Please Enter Their Name Below so They Can Receive Their Referral Rewards!

Which type of distraction would you prefer at your session?fisrt

Which type of distraction would you prefer at your session?fisrt
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Do you have any medical conditions I should know about? Select all that apply

Do you have any medical conditions I should know about? Select all that apply