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Full Name*
Email*
Phone*
Day and preferred time*
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Preferred length of session*
Have you been heathy and free of symptoms for the past 2 weeks?*
*Please share a few words about your intention and what is your reason for seeking me out today? Please share a few short words.*
Are you a returning patron or a new seeker?*
- Returning Patron
- New Seeker
New Seeker:
Your City, State of Residence*
Where did you find me?*
What draws you to my practice? How can I support you?
Your board handle or p411/rs2k member details
Choose a screening option.*
- Professional information
- Provider references
Professional Information
Link to professional website or Linked-in profile*
Work Email*
If company privacy is a concern, kindly email me a photo of your ID to paz@exquisiteoasis.com - I assure you of my discretion.
Provider References:
Provider reference #1:
Provider Name*
Contact Email*
Website or current online ad*
Provider reference #2:
Provider Name*
Contact Email*
Website or current online ad*
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Cancellation Policy: I require 1 day notice or a cancellation fee of 50% of your donation amount.*
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