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New Client Appointment Request

 Services are not covered by insurance - We do accept most HSA & Flexible Spending Accounts

We will email you appointment times within 24 hours, (if we believe that we can help you). Please email us to let us know that you submitted this form, as they sometimes get lost in cyber space! 

ALWStaff@outlook.com

Click Here To Learn About What To Expect During a First Appointment With Dr. Nelson

**Important Dr. Nelson only takes a few face to face appointments for new clients per month.  

Fill out the below form and Dr. Nelson will review

to see if she believes that she can help you.  

If she does not think so, she will honestly let you know.

First and Last Name

Street Address

City and State

Zip

Email

Confirm Email

Phone Number (with dashes)

Additional Phone Number (with dashes)

Reason for appointment - please be descriptive as Dr. Nelson will let you know if she believes that she can help you.

Services you would like:

Would you like a 30 minute footbath detox session - $40

Select an option

Additional Information

How did you hear about us?

Did someone refer you, if so, who?

Please call the office when you submit this form for fastest response at 724-260-5301 (sometimes the forms get lost in cyberspace!)

Select an option

We will be emailing you some times today, please check email, including junk mail folders

Select an option
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