Looking forward to 2021

1. Your Name and Information

2. What type of treatments/therapies are you interested in (please select all that apply):

3. Would you be interested in a small in person empowerment gathering (with masks and using COVID-19 CDC guidelines)?

4. It’s been a challenging year for all, so we would like to give back! In recognition of the new year, we would like to hear from you about someone in your life, a family member or friend, having a tough time. Nominate them below. Each month we will randomly choose a nominee to receive a self-care prize or spa experience.

5. Please provide a short description why you think this person would benefit from self-care!