Form

Email*

First name

Last name

Reason For Contact*

Verify Insurance Prior to Booking

Times listed do not work (Any Therapist)

Times listed for Luke/David don't work

Once you hit "Submit" you will:

1) Automatically be directed to fill out our HIPAA compliant New Patient Demographics form and verify your email.

2) Be able to upload a picture of your insurance card and our team will reach out with any information regarding your coverage. Please note, we are an out of network provider.

3) Finally, you will receive an email with Subject line: "New Patient Intake Part 2"

This email contains a link to fill out your New Patient Medical History and Consent to Treatment forms, which must be completed prior to your first visit.

If you are unable to complete this second form now, or would prefer to wait to hear about your coverage, be sure to save this email for you to complete later.

We look forward to welcoming you to our studio! An email with all this information and links will be sent to you directly upon hitting Submit.

Is there anything else we should know?

For Example: Preferred Therapist - Days/Times you are available