Appointment Request/Waiting List

• I AM NOT CONTRACTED WITH ANY INSURANCE COMPANIES. PLEASE SEE FEES PAGE FOR MORE INFORMATION.

• I SEE CLIENTS 21 YEARS OF AGE AND OLDER

• 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.

I AM ACCEPTING INDIVIDUAL CLIENTS 21 YEARS OF AGE OR OVER.  

I AM ONLY ACCEPTING MARRIED COUPLES ON A LIMITED BASIS.  THE FEE IS $200