New Client Form

**This New Client form is for anyone requesting an appointment with Gary for the first time that DOES NOT require a Full Consultation. Please take the time to fill this out completely.

MASK info: For reference - For medical reasons Gary does not wear a mask in session and does not require his clients to wear one either. If you choose to wear a mask that is your choice. If this is not acceptable then you may try again another time in the future when you are more comfortable with this policy.

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

Name *

First

Last

Email *

Cell Phone Number *

Your Age *

Do you have a Gift Certificate or Voucher *

*NOTE: If your voucher has expired please refer to Gary's
Voucher Reactivation program for details about your options

I have fully read the 'Mask info' section at the top of this form and agree/consent to this policy without objection *

Yes

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 *

Full name of your Referral (Type N/A if you do not have one) *

Are you Pregnant? *

Yes - *Restricted services only No

Do you have any Medical conditions/ chronic problems? *

Please list any and all medications you are taking *

What type of session do you want? *

NOTE: Saturday appointments are reserved for regular clientele
- All New Clients must schedule Mon-Fri during posted hours before
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)

Please request specific dates/times here: *

Additional requests, comments or questions here: *

Submit

New Client Form

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