Wellness Payment Form

*First Name
*Last Name
*Address 1
*City
*State
*Phone
*Email
Day and time of session booked
*Payment Options

Please choose the payment for the session that you have confirmed booking for.

Deposit Only (non-refundable) ($50)
30 minute session ($60)
45 minute session ($80)
60 minute session ($100)
90 minute session ($140)
hot stone 90 minute ($200)
*Practitioner
Kim Adami
Ricia Fleming
Uli Kapp
Kate Smyers
Carrie Lynch
Additional Gratuity (optional)
$
Only number values are allowed
Other requests or concerns
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