Name *

First Name

Last Name

Phone

(###)

###

####

Address *

Address for location where sound bath will be held

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Travel Fee Acknowldegement *

I acknowledge that a travel fee of $30 is applied to any location outside of Utah County

Retainer Fee *

I acknowledge that a retainer of $50 is required to hold my appointment on your calendar. Remaining balance is due at the time of service (cash or Venmo). Retainer can be paid through Venmo (@rewildingbirth)

I also acknowledge that the $50 retainer fee is non-refundable

Appointment Changes *

I acknowledge that any changes to my appointment (location, time, date, etc.) must be finalized AT LEAST 48 hours in advance. Any changes made after this point may or may not be accomodated.