1.  First and Last Name  

NEW CLIENTS:  Please indicate who referred you to me 

2.  Home or Cell Phone  

3.  Valid Email Address  (required for me to confirm my appointment with you)

4. Verify Email Address 

5.  Date Requested (must be open on my availability calendar)    Appointments are filled on first come, first serve basis and are subject to adjustment.

6.  Time Requested (must be open on my availability calendar)  Appointments are in 20 minute increments (7:00, 7:20, 7:40, etc.) on weeknights and half hour increments on Saturdays. If you need additional time with me, please request a Saturday appointment or two weeknight appointment slots.


7.            8.    You will receive a confirmation email within 24 hours, verifying our appointment.  If any information submitted is not valid, it will be ignored.  This request does not change any information on this website.

APPOINTMENT CHANGES:  If you have a scheduled appointment and need to make a change, or have a comment, please enter it here: