Full Name
*
Email
*
Phone
*
Reason for Cancellation
*
Moving away
Medical
Financial
Dissatisfied with Services
Scheduling
Other (please elaborate below)
Other (reason for canceling, ways for us to improve, feedback you'd like to share, etc.)
Cancellation Policy
By checking this box I acknowledge the following cancellation policy Notice of cancellation must be made 30 days prior to the end of contract schedule or billing date. If notice of cancellation is not made, membership will continue month to month until a 30 day notice from final billing date is sent. If cancellation is made prior to the end of the contract term, client will incur a charge of 2 months of membership dues plus a $100 cancellation fee. THERE ARE NO REFUNDS.
I agree to
terms & conditions
provided by the company. By providing my phone number, I agree to receive text messages from the business.
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