NEW CLIENT REQUEST FORM:


PERSONAL INFORMATION:
Name *
Name
Preferred Phone Number *
Preferred Phone Number
What is your preferred initial method of contact? *
Watch to The Code of Conduct Video HERE: https://www.youtube.com/watch?v=hxSQLt-dinA
APPOINTMENT PREFERENCES:
What kind of session are you looking for? *
(For descriptions of each, watch the video on the top right)
Your preferred location(s) for your session? *
(Travel Fee Required outside of Janet's Studio in San Antonio, TX: $20 fee within 10 miles, $40 for 10-20 miles. No fee for people with disabilities)
(Minimum of 60 minutes to as many hours as you may think you need)
ONLY FOR NEW RETOUCH CLIENTS:
What is the name of your therapist / medical professional?
What is the name of your therapist / medical professional?
(If you need a therapist/medical professional to work with, I have my preferred providers)