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Request Appointment

If you are interested in receiving services, please fill out the form at the botom of this page to request an initial appointment.  We will try to accomodate your request or offer another possible appointment time.

Prior to your appointment, please print and complete the two forms below and bring them to the agency with you at your scheduled appointment time.  If you cannot print the forms and complete them in advance, please arrive 15 minutes early for your appointment so you can complete these forms before your intake interview.

Please also remember to bring in the required information to your first visit. (See Information Needed at First Visit below.)  
If you do not bring this information services may be delayed.  There is no charge for the initial visit.  However, if you miss your first appointment without notifying us 24 hours in advance, you will be charged $40 and will be required to pay this fee before we offer you another appointment.

 

Application for Service
Client Information Form

Application for Service - Spanish
Client Information Form - Spanish

 

Information Needed at First Visit 
 

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

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By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.