Float-for-a-Cause Inquiry

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If you or someone you know is suffering from symptoms related to PTSD or other health issue and would like to try floatation therapy, but cost is a factor, please complete this form to set up a confidential, free or "pay what you can" appointment.

Email *

Applicant Name *

Phone

Tell us a little about your situation and why you would like to apply for this program (your answers will remain confidential) *

Have you every tried floatation therapy? *

Yes

Please select one *

I am unable to pay for service

I would like to "pay what I can" (please indicate amount below)

Amount you are able to pay towards service

Comments

Submit

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