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Welcome
Home
About Us
Become A Client
Become a Provider
Get In Touch
Welcome
NEW CLIENT REQUEST FORM:
PERSONAL INFORMATION:
Name
*
First Name
Last Name
Preferred Email Address
*
Permission to add to Janet's newsletter. NO Spam
Preferred Phone Number
*
(###)
###
####
What is your preferred initial method of contact?
*
Email
Phone call
Text
Smoke Signals
What would you like for Janet to know about you?
*
Are you familiar with Touch Is Medicine's Code of Conduct?
*
Watch to The Code of Conduct Video HERE: https://www.youtube.com/watch?v=hxSQLt-dinA
Yes!
No (see the video link listed below )
APPOINTMENT PREFERENCES:
What kind of session are you looking for?
*
(For descriptions of each, watch the video on the top right)
Empowered Platonic Touch/Cuddling Session $100
Supportive Platonic Touch/Cuddling Session $120
ReTouch: Rehabilitative Touch Therapy collaborating with your therapist/doctor $120
Life Coaching Session $80 (I prefer walking in nature/on a SA Greenway coaching session)
Other
Your preferred location(s) for your session?
*
(Travel Fee Required outside of Janet's Studio in San Antonio, TX: $20 fee within 10 miles, $40 for 10-20 miles. No fee for people with disabilities)
MY STUDIO SPACE: couch, lovesac, bed, outdoor evening setting for cooler weather, hammock, etc.
YOUR PERSONAL SPACE: home, hotel, office, rental, etc.
A FAVORITE PUBLIC PLACE: restaurant, café, park, etc.
GENERAL COMPANIONSHIP: athletic game, dancing, concert/theater, festival, etc.
MEDICAL APPOINTMENT: If you would like me to travel to attend your appointment with you.
OTHER: Submit your answer below...
What would you like to get out of our session together?
*
Request a session length:
*
(Minimum of 60 minutes to as many hours as you may think you need)
There is a sliding scale available. Would you like more info on this?
*
Yes
No
I don't know now. I'll get back to you.
ONLY FOR NEW RETOUCH CLIENTS:
What is the name of your therapist / medical professional?
(If you need a therapist/medical professional to work with, I have my preferred providers)
First Name
Last Name
What is the contact information of your therapist / medical professional?
Thank you!