Please fill out this form to assist us in contacting you at your convenience. 

Name *
Phone Number *
Phone Number
Preferred form of contact: *
Please let us know how you'd like to be contacted.
Best day(s) to contact you: *
Please let us know which day(s) are best to receive contact.
Best time to contact you: *
Please give us a time span that works best on your preferred day(s).
Which services are you seeking?
Note: massage and hypnosis are not accepted through insurance. Please check all that apply.
Please clarify any information you feel is necessary to clarify for us and to determine which therapist is the best fit for you. This may include the purpose of your call or specifics on the best day and time to contact you.