New Patient Intake Form
Please complete the following Intake Form and return to us at least 24 hours prior to your Initial Appointment.
Any fields that are marked with an asterisk *, are required to be entered before your form can be submitted.
Please note that payment is due on the day of treatment. We request at least 24 hours notice to change or cancel appointments. A $50.00 administration fee will be charged for late cancellations/changes or non attendance of appointments.