Scheduling Policy

Scheduling Policy
Client name

First NameLast Name
Responsible party if other than client.

First NameLast Name
E-mail
example@example.com
Phone number
Please enter a valid phone number.Format: (000) 000-0000.
As we are an appointment only office, we have reserved time in our schedule exclusively for you. Out of respect for our trainer and clients we ask the following:
We reserve the right to waive charges at our discretion due to special circumstances.

We look forward to meeting with you and guiding you through your journey!

By checking all the above boxes and signing below, you agree to West Seattle Neurofeedback’s Scheduling Policy.
Signature
Date signed

MonthDayYear
Date
Should be Empty: