ALTERNATIVE FORM LINK ( If you are having "SECURITY WARNINGS", you may use this link to complete this form.)
 
Bioenergetic correction is not typically a health insurance reimbursable item. Some medical savings plans do allow for these services if they are billed as acupressure for allergies or pain control. 

Bill my credit or debit card twice a month for the sessions provided to the client. Bill my credit or debit card for the session(s) I received. I accept that it is my responsibility to keep track of the time I use or ask the Practitioner how much time I have used at the end of each session.

If you have a session with a practitioner, then an invoice will be incurred and your credit card will be charged at the end of the bi-monthly billing period during which your session occurred.  You are not billed if you do not have a session with a practitioner.

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