Couples Appointment Request

Couples Appointment Request
Appointment is not confirmed until our scheduling team contacts you. Please allow 24 business-hours for a return call.
Guest 1
Guest 1 Name*
Gender Preference for Therapist*

NoneMaleFemale
Email*
Phone Number*

Area CodePhone Number
May we text to that Number?*

YesNo
How did you hear about us?
Will you be using a Voucher or Gift Certificate?

YesNo
Voucher or Gift Certificate Number
Appointment Date Requested

MonthDayYear
Date
Appointment Time Requested

AMPM
Guest 2
Guest 2Name*
Gender Preference for Therapist*

NoneMaleFemale
Email
Phone Number*

Area CodePhone Number
Treatment Enhancements

A variety of treatment enhancement upgrades are available for an additional charge. Please ask one of our team members for more details.
We thank you for your appointment request. This appointment request will be reviewed by our scheduling team and one of our team members will be contacting you within 24 business-hours, excluding weekends, to confirm the availability and details of your request. If you have alternate dates/times, or other information to include, please use the Comments and Questions section, below.
Comments or Questions
Should be Empty:

Appointment is not confirmed until our scheduling team contacts you. Please allow 24 business-hours for a return call.