Request Care

Request care after your initial consultation.

Use this form when you are ready to request services. Submission does not confirm a booking or guarantee availability.

Request Care

Please do not include detailed medical information, medication lists or highly sensitive health information in this form. Approved clients will receive a secure intake form and care agreement separately.

Submitting this form does not create a service agreement. Services are confirmed only after assessment, written acceptance, a signed care agreement, and receipt of cleared payment in full.