Kindful Body Email Form

Name *

Email *

Phone Number

Are you a resident of California? *

Preferred method of contact. *

Email Phone

How can we help you? *

How did you hear about us?

Privacy & Security

I understand that the use of email is inherently insecure and thus poses a risk to the security and confidentiality of my protected health information and consent to Kindful Body staff communicating with me by email.

Acceptance of Privacy & Security *

I consent to the terms of Privacy & Security as outlined above.