Wellness Update

Name(Required)

First Last

When was your last visit (approx)

MM slash DD slash YYYY

How has your level of health and wellness changed?

Would you like to be contacted about this before your next visit?(Required)

YES

No, this is just an update

How would you like to be contacted?

Phone

Text message

E-mail

What number would you like to be contacted at?

What number should we send the text message to?

What email would you like to be contacted at?

Enter Email Confirm Email

Contact Us

402-780-1707
Email Us
5600 South 59th #104
Lincoln, NE 68516

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**24 hour cancellation policy applies to all cancellations/ reschedules within 24 hours, including illness. Please consider adding the $15 insurance policy to avoid the 100% cancellation/ rescheduling fee.

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