Justine’s Waitlist
Use if you can’t find an appt that works, or you want in sooner!
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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? *
Required
Typically, what time is day is best? *
Required
Thanks!
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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