You Can Request An Appointment With This Form

Please use this form to request an appointment or call (415) 927-7565

If you're already a patient, please feel free to request a treatment session with this form.
If you're new to Body In Balance please select the consultation option.

(All new patients must begin with a consultation/evaluation before starting treatment.)

Consultations are $65. (approx. 30 minutes)
The initial treatment, to be scheduled later, is $165. (approx. 1 1/4 hour)
And all regular follow-up treatments from then on are $135. (1 hour)

(The information you provide is completely confidential, and will not be shared.)

1.	Your name and how to contact you:

	Name:
	Email address:
	Daytime phone:
	Evening phone:

2.	Treatment or consultation?

	(Please select the consultation option if you're a new patient and haven't already had one.)

	Consultation
	Treatment

3.	When would you like your appointment?

	Clinic hours are Noon to 6 PM, Monday through Friday. (Skip this part if you have no preferences.)

	My first choice is:
	At the following time:

	My second choice is:
	At the following time:

4.	What is the problem you need help with?

	Please use the space below to briefly describe your problem and for any additional comments or questions:



	When you're finished, just click the send button below.

BODY IN BALANCE · 21 Tamal Vista Blvd, Corte Madera, California 94925 USA · (415) 927-7565