Legal Name *

First Name

Last Name

Preferred Name

First Name

Last Name

Which service(s) are you interested in? *

Acupuncture

Cupping

Herbal Consultation

Auricular Acupuncture

LED (Light Emitting Diode)

Pelvic Steaming/Smoke

Facial Acupuncture or Microneedling

Selected your preferred clinic location *

New York City

Wallkill/Bloomingburg, NY

I confirm that I've read and understand the COVID-19 safety procedures and that I'm required to wear a mask for the duration of my in-person visit *

Yes, I confirm and understand

Cancellation Policy *

I understand there is a 48 hr cancellation policy on facial appointments and a 24 hr cancellation policy on ALL other appointments. All late cancels are subject to charge the full amount of the service you booked.

Yes, I understand