New Client Appointment Request Form
Great! For the love of health, you are ready to make an appointment. How can we help?
Full Name
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First Name
Last Name
Mobile Number
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Please enter a valid phone number.
Email Address
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example@example.com
What date and time work best for you?
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Second best available time and date option?
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Third best available time and date option?
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How much time are you considering investing into your appointment?
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We will do our best to accommodate a schedule that works for you. Are there any other details regarding scheduling you'd like to add? (Example: "any time between __:__ and __:__" or "I have the whole date of ___/___ off but can't do after __:__")
What services are you interested in? Please give a brief description of your goal and reason for scheduling.
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If you are in pain, please give a brief description of what hurts, and any other details that may be relevant. Did another professional recommend bodywork/massage?
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Would you prefer to be reached out to by email or text?
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Email
Text
Would you like to be notified via email about upcoming promotions and services?
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Yes
No
Can't wait to meet you. Give a should out to who referred you (if applicable)
By checking here, you agree to understanding that this is an appointment REQUEST and does not guarantee any services or appointments. Uplift by Colette has the right to refuse services. You may be required to provide further details regarding your request before scheduling. There will be an intake done at the time of service before treatment begins. You may be advised to try a different type of treatment based on your goals. The practitioner will further assess and guide you on the appropriate service if needed. Not all services are appropriate for every client or condition.
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