About You
First Name
*
Last Name
*
E-mail
*
Phone Number
*
Format: (000) 000-0000.
City
*
Please select what applies to you
*
Please Select
New Client
Returning Client
Address
What Brings You In ?
What is the main reason you’re booking this experience?
*
Please Select
Stress relief
Release of stored trauma/emotional tension
Tightness/stiffness
Pain relief
Mobility/flexibility improvement
Relaxation
Nervous system reset
Other
If you have a different reason, please let us know.
How's Your Body Feeling ?
Where do you feel the most tension or emotional holding ?
*
Is what you’re feeling mostly:
*
Please Select
Physical
Emotional
A mix of both
What have you tried already? (Select all that applies)
*
Yoga/Pilates
Massage
Chiropractic
Physical therapy
Self-stretching
Prayer/meditation
Nothing yet
How would you rate your flexibility/mobility?
*
1
2
3
4
5
6
7
8
9
10
Very Stiff
Extremely Flexible
1 is Very Stiff, 10 is Extremely Flexible
Your $129 Nervous System Evaluation + Reset
Your first session is only $129 (normally $360). After this session, most clients move into our 3-Session Reset Trio to continue their progress. Would you be open to hearing your practitioner’s recommendation?
*
Please Select
Yes
Maybe
Not right now
How soon do you want to come in?
*
Please Select
Today
Within 48 hours
This week
Next week
Would you like help booking your session?
*
Please Select
Yes
No
CONFIRM Preferred Service Location
*
Please Select
Lanham/Bowie
Bethesda
Referral Source
*
Please Select
Facebook
Instagram
YouTube
Google Search
Sherrell Duncan
Dr. L Nicole
Family/Friend
Other
Please let us know how you found out about us.
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REQUEST MY RESET
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