Justine’s Waitlist
Use if you can’t find an appt that works, or you want in sooner!
Sign in to Google to save your progress. Learn more
Your full name: *
Your phone number or email (preferred place to be notified of an opening): *
What's your ailment? Have you had any treatment for this issue recently? Please rate pain on scale of 1-10: *
Which day(s) work for you? *
Typically, what time is day is best? *
I'll be referencing this list throughout the week and contacting you in order of receipt as well as availability. Feel free to complete this form again if your symptoms or availability changes.
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