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Facial Cup After Care
**This New Client form is for anyone
requesting an appointment with Gary for the first time that
require a Full Consultation. Please take the time to fill this out completely.
New Client Form
**Availability is first come first serve and Gary tends to book out about 2 weeks in advance (sometimes longer during peak times) for most new clients depending on availability.
Indicates required field
Cell Phone Number
Gary's scheduling software automatically sends out a text reminder prior to your appointment
Do you have a Gift Certificate or Voucher
Finding Source Gift Certificate
Groupon/ Living Social - Limit 1 Per New Client
If your voucher has expired please refer to Gary's
Voucher Reactivation program
for details about your options
If you purchased from Groupon/Living Social or Gary's New Client Offer which option did you buy?
1 Hour Session
90 Minute Session
Full Name of Person who purchased your Certificate or Voucher
Voucher/Certificate Number **NOTE: Groupon/Living Social Customers - You cannot be scheduled without your 8 digit Bar Code number
Please include your 8 digit Bar Code number for proper verification
Full name of your Referral (Type N/A if you do not have one)
If you have a Groupon or similar voucher or do not have a referral then just put N/A in this line.
Are you Pregnant?
Gary's massage style is not suited for pregnant women unless you are beyond the 40 week mark, However Reflexology, Facial Cupping, Vibrational Tuning and Consultations are available
Do you have any Medical conditions/ chronic problems?
If No - Type: NONE - If Yes please give a brief description *Example: Bulging Disks lower back, Stiff Neck, Insomnia or Trouble sleeping
Please list any and all medications you are taking
If No - Type: NONE - If Yes please give name and what it is for *Example: Lipitor - cholesterol, Ambien - trouble sleeping
What type of session do you want?
Myofascial Decompression (Targeted Cupping 30 min)
Facial Cupping - A Natural Facelift
Axiatonal Integration - Please allow 2+ weeks to schedule
Need to Discuss
If you are not familiar with Gary's style of work or have specific medical issues then just choose the "Need to Discuss" option
Saturday appointments are reserved for regular clientele
- All New Clients must schedule Mon-Fri during
being eligible for a Saturday time slot
Monday-Friday: Day & Time frame preferences - Check all that apply
First Available - Anytime
Early - 11am to 2pm (Mon-Fri)
Mid afternoon - 2pm to 4pm (Mon-Fri)
Late Afternoon - 4pm to 6pm (Mon-Thurs)
*Note - During Peak times, late afternoon appointments will fill up first, so the more flexibility you have in your daytime schedule will generally get you in sooner
Please request specific dates/times here:
Additional requests, comments or questions here:
- Pain Management
- Pain Elimination
- Self Empowerment
- Self Reliance
- Greater Health & Vitality
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