Patient Inquiry Form

Not sure what service(s) you might need…

Take a moment to complete this form and I’ll reach out so we can

further discuss what service(s) would honor you best.

Name

First Name

Last Name

Phone

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Email

Patient Type

What service(s) are you interested in?

Acupuncture

Cosmetic Acupuncture

Microneedling

Hypnotherapy

Herbal Medicine

Choose your preferred acupuncture session type

Is there anything specific you'd like me to address or answer before booking a session or making any recommendations to support you?