Heal-Thy Sol LLC Therapeutic Touch 
New Client Consultation Form
Email *
First & Last Name 
(include preferred name & gender pronouns)
 *
Cell Phone (text preferred) *
Social Media Links
(this helps us verify your identity)
 *
Do you identify as an individual in the QT2s+BIPOC Community? *
How did you hear about us? Did someone refer you? *
Which offering are you most interested in? *
Required
Tell us why you would like to work with us? *
Do you have a gift card/certificate? *
Is there anything else you would like to share with us prior to scheduling a consultation? *
I understand that Heal-Thy Sol is a private home-based practice. *
Required
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