Name *

First Name

Last Name

Phone *

(###)

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Appointment Reminder *

Our computer system sends out automated email or text reminders 24 hours before your appointment. How would you like to receive reminders?

Email reminder

Text reminder

Both email & text reminder

Cancellation Policy *

I acknowledge that The Walking Therapist charges full sessions fees for appointments which are cancelled less than 48 hours before the appointment time.

I acknowledge