Patient Intake

Select Appointment Date:

What Kind?   (Please select a service)

Select a service…MassagePhysiotherapy
Please select a treatmentMassage 30 min – $50Massage 45 min – $75Massage 60 min – $100Massage 90 min – $150Physiotherapy Initial Assessment (one body part) – $100Physiotherapy Initial Assessment (two or more body part) – $120Physiotherapy Treatment (one body part) – $85Physiotherapy Treatment (two or more body part) – $100

Personal Details:

 

Do you have insurance?

YESNO

Previously visited?

YESNO