Home Clinic Appointment Request Form
Please read carefully: My home practice is open to existing patients, as well as new patients seeking breast/chest and oncology care, prenatal, postnatal, or post-cesarean section massage. For all other treatment types, please book with me at Spectrum Treatment Centre in Castlegar. Thank you!
Full Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
Which treatment type are you seeking? (Select all that apply)
Prenatal RMT Massage
Post-Cesarean Section RMT Massage
Breast Cancer Related Surgery RMT Massage
Elective Breast/Chest Surgery RMT Massage
Gender-Affirming Top Surgery RMT Massage
RMT Facial Massage
Other
Are you a
New Patient
Previous or Current Patient
Your treatment needs, goals, or questions:
Please specify your availability
Morning
Afternoon
Tuesday
Wednesday
Thursday
Use this section if you need to clarify availability
Any additional information you'd like to add
I'm aware that there is a dog present at the home clinic and will communicate with Rachel if I have concerns regarding this.
*
Yes
I understand that this form is for sharing my needs and availability. Rachel will review my submission to see if she’s the right fit for my care, and an appointment is only confirmed once she contacts me directly.
*
Yes, I understand
Submit
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