• Client Intake

    Hello! Our intake takes a little time. We have one shared intake form, which means you only fill out one form for all of our practitioners. Thank you for taking the time to tell us about yourself. Please read the following statements, and fill out our intake. Please let us know if you have any questions. Call / Text (401) 300-5010
  •  - -Pick a Date
  • Sick Policy

  • This office does not accept sick visits. We ask that if you have any symptoms of any contagious illness that you stay at home. This includes but is not limited to new cough, cold, fever, chills, new difficulty smelling, new difficulty tasting, new diarrhea, contact with anyone sick, contact with anyone COVID positive or quarantined. Addiitonally, anyone with athletes foot cannot participate in massage or foot reflexology.  

     *notify us right away with any changes

     

    Click here for our COVID precautions https://holisticri.com/covid-precautions/

  • Getting to know you

    and your main concerns
  • Safety and History

  • ♦️Please Read Carefully: This section will guide to to the appropriate waiver for your visit

  • General Notices, Rights, and Waivers

  • Privacy

  • Appointments Cancellations

    We request a minimum of 2 business days notice for full refund, so that we are able to fill your spot and call those on the waitlist. Early cancellations are subject to cancellation fee up to full fee of service. No show will result in full payment.
  • General Notice

    If you sign up for a membership: 60 day written notice required to cancel any membership. Cancellation fees may apply. Cancellation fees may be waived if the contract commitment has been met. Memberships are nontransferable, and nonrefundable. Failed payments subject to fee of $50.
  • General Terms of Use

    For terms of use: https://holisticri.com/terms-of-use/
  • Clear
  • Your HIPAA rights

  • Please review your HIPAA rights

    Copy and paste this link into a browser if you are unable to view the PDF below https://holisticri.files.wordpress.com/2020/11/npp_fullpage_hc_provider.pdf

  •  - -Pick a Date
  • Clear
  • Reflexology and Manual Therapies

  • Clear
  • Health Coaching

  • I am authorizing Holistic RI to charge my credit card on file in the amount of dollars on a monthly basis. I am additionally authorizing my credit card on file to be automatically charged for any outstanding amounts, fees incurred, or cancellation charges.

  • Clear
  • Depth Hypnosis, Transformational Coaching & Integrative Energy Medicine

  • Clear
  • Clear
  • Telehealth

  • Clear
  • Functional Medicine

  • Clear
  • FEES

    Functional Medicine is offered as a membership service.
    I,         am signing a six month membership agreement with Holistic RI. My new member fee (joiner's fee) is  $     . My monthly membership fee is  $       .

    Before your first appointment, you will be billed both the joiner's fee and the monthly fee. Your membership includes one to two visits per month as needed, for a total of 5 visits during a 6 month period. This does not include additional costs of stool testing, blood work, supplements, or medications. You are authorizing yourcredit card on file to be automatically charged on a monthly basis for the aforementioned amounts.

    *Fees are subject to change. The patient will be notified regarding any changes.

  • Clear
  • JOIN OUR EMAIL NEWSLETTER: Optional

    Please enter your email here only if you would like to be added to our emailing list
  • Submit

    Please submit the form by clicking the button below
  • Should be Empty: