Private Practice Workshop

Private Practice Workshop

January 13th, 2026. 9am-12pm
Customer Details:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
Payment

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Paypal/Credit CardCheck/Venmo

Check/Venmo
Private Practice Workshop: $125.00

Please make check payable to:

Nicole Wolasz
Phoenix Therapy and Wellness
337 Cleveland Drive, Suite 6
Cheektowaga, NY 14215

Please mail immediately - must be received within 7 days of registration.

Payment via Venmo: Pay to @nicole-wolasz

Cancellation Policy:

No refunds after the starts of the program. There will be a $50 fee for those cancelling 7 days or fewer day prior to the start of the workshop.

Paypal/Credit Card
Cancellation Policy:

No refunds after the starts of the program. There will be a $75 fee for those cancelling 7 days or fewer day prior to the start of the workshop.
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