Appointment Request

To request an appointment, please complete the form below. If you are an established client please indicate which practitioner you would like to have an appointment with in the comments field. You may also comment on the type of appointment you would like i.e. group acupuncture, new patient, 1 hour, etc. A member of our staff will contact you to confirm your appointment. Your appointment is not made until a staff member contacts you to confirm. Please do not use this form to cancel or change an existing appointment. If you do not hear back from us within 24 hours please call the office at 970-247-2043.

Required fields are shown in bold.
First Name:    MI:   Last Name: 
     
Address Line 1:
Address Line 2:
City:   State/Province:   Zip/Postal Code: 
   
Email Address:    
Phone:     Alt Phone:   Best time to call:
   
Will this be your first appointment with us?
Preferred day for appointment:
Preferred time for appointment:
Comments:
Note: Appointment requests made through this service are not considered confidential.
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