INTAKE
INTAKE FORMS
please note: click here to download PDF and print or fill out below and email
Click here to download Anatomy Form please print and fill out
To better customize our treatment to your needs all forms must be completely filled out prior to the first session.
We need to receive prior to your appointment:
1. Intake Forms
2. Anatomy Chart
3. Financial Agreement
4. Payment for 90 minute Initial Consult & Treatment, applicable to your local
Mail to:
EarthDancer Wellness
PO Box 3366
Half Moon Bay, CA 94019
along with a check for payment made out to:
Samantha Corsiglia
prior to your scheduled appointment.
Make copies and bring with you, in case USPS fails to deliver. Thank you.