Appointment Request Form

Please give us at least 3 hours advance notice in requesting an appointment time. While we do our best to ensure that you get the time and date you request, submitting this form does not guarantee an appointment, as availability and schedules are subject to change.

Name *
Phone *
Preferred method of contact: *
Do you require a first floor room? *
Most of our treatment rooms are located on the second story, however we do have one room on the ground floor. If you have any mobility issues we would like to ensure this room is available for you at your time of appointment.